ABSTRACT
STUDY OBJECTIVE: To analyze the reproductive outcome of hysteroscopic adhesiolysis and assess the diagnostic accuracy of transvaginal ultrasonography (TVS) in infertile women resulting from intrauterine adhesions (IUAs). DESIGN: Retrospective, cross-sectional study (Canadian Task Force classification II-2). SETTING: University tertiary referral center. PATIENTS: Three hundred and fifty-seven patients with mild, moderate, and severe IUAs who underwent hysteroscopic adhesiolysis between January 2012 and December 2015. INTERVENTIONS: Hysteroscopic adhesiolysis in the outpatient analgesic setting for infertility and IUAs. MEASUREMENTS AND MAIN RESULTS: Among the 357 patients (135 with mild IUAs, 116 with moderate IUAs, and 106 with severe IUAs) who underwent hysteroscopic adhesiolysis, 334 (93.6%) experienced a completely restored uterine cavity. The reproductive outcomes of 332 women (93%) were followed for an average duration of 27 ± 9 months, and the overall conception rate after hysteroscopic adhesiolysis was 48.2%, which decreased with increased IUA severity (mild, 60.7%; moderate, 53.4%; severe, 25%). The mean time to conception following hysteroscopic adhesiolysis was 9.7 ± 3.7 months. The miscarriage rate was 9.4%, and the live birth rate was no lower than 85.6%. Eleven patients (7.9%) had postpartum hemorrhage, including 6 (4.3%) due to adherent placenta and 3 (2.1%) due to placenta accreta. CONCLUSION: Hysteroscopic adhesiolysis is a feasible and effective way to improve fertility in patients with Asherman's syndrome.
Subject(s)
Gynatresia , Hysteroscopy , Infertility, Female , Reproductive Health/statistics & numerical data , Adult , China/epidemiology , Cross-Sectional Studies , Dissection/adverse effects , Dissection/methods , Female , Fertilization/physiology , Gynatresia/diagnosis , Gynatresia/epidemiology , Gynatresia/etiology , Gynatresia/surgery , Humans , Hysteroscopy/adverse effects , Hysteroscopy/methods , Infertility, Female/diagnosis , Infertility, Female/epidemiology , Infertility, Female/etiology , Outcome and Process Assessment, Health Care , Retrospective Studies , Severity of Illness IndexABSTRACT
OBJECTS: This paper explored the suitable population for the combined therapy of hysteroscopic resection and oral megestrol acetate (MA) to treat local stage I endometrial cancer. Therapeutic effectiveness, safety, as well as pregnancy rate and relapse rate after treatment were also examined. The aim was to provide guidance for the treating similar cases in the future. METHODS: This perspective study analyzed the clinical data of early stage endometrial cancer patients who have received combined therapy of hysteroscopic resection of local endometrial lesion and oral administration of MA at the Obstetrics and Gynecology Hospital of Fudan University, Shanghai. RESULTS: A total of six patients met the entry criteria and were enrolled into the trial. All of them achieved a pathologic complete response to hysteroscopic resection of local lesion combined with oral administration of MA for 3 months to 6 months. Among the patients, three became pregnant after natural conception and had healthy infants delivered vaginally at full term without assistance. No relapse occurred in the follow-up study over 48.5 months on average. CONCLUSIONS: In early-stage endometrial cancer, young patients who had already given birth demand may receive hysteroscopic resection combined with oral administration of MA as conservative treatment. The patients can consider natural conception after complete remission, but a close follow-up was crucial to ensuring that the patients were free from other factors affecting childbearing ability.
ABSTRACT
OBJECTIVE: To evaluate the clinical characteristics of pelvic lymph node metastases in patients with early-stage cervical carcinoma. METHODS: The clinical, pathologic and follow-up data of patients with cervical carcinoma treated at our hospital from June 2006 to May 2008 were collected and analyzed retrospectively. The relevant literature was reviewed. RESULTS: The median age at diagnosis was (45.6 ± 3.8) years old. Among these patients, 587 patients (92.3%) were of squamous cell cervical carcinoma while 49 patients (7.7%) cervical adenocarcinoma.But the differences of pelvic lymph node metastases were not significant(P > 0.05). The overall prevalence of lymph node metastasis was 10.9% (69/636). The rate of pelvic lymph node metastases became significantly high up from the clinical stage I(b1). When the pelvic nodes were positive, the obturator group was involved in 69 cases (69/120). CONCLUSION: There is an increased rate of pelvic lymph node metastasis in the patient groups of clinical stage I(b1)-II. And the obturator group is predominantly involved. Thus a routine pelvic lymphadenectomy is essential.
