The influence of timing of oocytes retrieval and embryo transfer on the IVF-ET outcomes in patients having bilateral salpingectomy due to bilateral hydrosalpinx.

Objective: The objective of the study was to investigate whether the sequence of oocyte retrieval and salpingectomy for hydrosalpinx affects pregnancy outcomes of in vitro fertilization and embryo transfer (IVF-ET) patients. Study Design: There were 1,610 bilateral hydrosalpinx patients who underwent laparoscopy salpingectomy and IVF-ET/intracytoplasmic sperm injection (ICSI) from January 2009 to December 2018. They were divided into two groups: oocyte retrieval first group: 235 accepted oocyte retrieval before salpingectomy; operation first group: 1,375 accepted oocyte retrieval after salpingectomy. The basic information and pregnancy outcomes of the two groups were compared. The pregnancy outcomes and influencing factors were analyzed among patients at different starting times of frozen-thawed embryo transfer (FET) or oocyte retrieval after the salpingectomy. Results: Patients in the oocyte retrieval first group had higher levels of basal follicle stimulating hormone and lower anti-Mullerian hormone levels (P < 0.05). There were no cases of pelvic infection or oocyte and embryo contamination after oocyte retrieval in the oocyte retrieval first group. In the frozen cycle, the clinical pregnancy and miscarriage rates of the oocyte retrieval first group were lower than those in the operation first group (P < 0.05), while the live birth rate was not significantly different (P > 0.05). The live birth rates of patients ≥35 years old in the operation first group and the oocyte retrieval first group were not significantly different (29.3% vs. 23.3%, P = 0.240). After adjusting for age and antral follicle count (AFC), oocyte retrieval 4-6 and 7-12 months after the operation had higher accumulated pregnancy rates [OR 1.439 (1.045-1.982), P = 0.026; OR 1.509 (1.055-2.158), P = 0.024] and higher accumulated live birth rates [OR 1.419 (1.018-1.977), P = 0.039; OR 1.544 (1.068-2.230), P = 0.021]. No significant difference was observed in the pregnancy outcomes of frozen embryo transfer at different times after salpingectomy (P > 0.05). Conclusion: No contamination of the embryo or infection was observed in patients who underwent oocyte retrieval before the operation. The interval between the operation and frozen embryo transfer did not affect the pregnancy outcomes. After adjusting for age and AFC, patients who underwent oocyte retrieval 4-6 and 7-12 months after the operation had higher accumulated pregnancy rates and live birth rates.

Anesthesia Management and Outcomes of Laparoscopic Surgery for Early Pregnant Women with Tubal Pregnancy:a Report of 48 Cases / 中国微创外科杂志

Objective To summarize the anesthesia management in laparoscopic surgery for early pregnant women with tubal pregnancy. Methods Forty-eight women diagnosed as early intrauterine pregnancy combined with tubal pregnancy from January 2010 to July 2014 were enrolled in this retrospective study.All the patients received laparoscopic surgery under endotracheal intubation and total intravenous anesthesia.Their general conditions, perioperative conditions, pregnant complications, pregnant outcomes and newborns status were recorded. Results All the patients were operated successfully and recovered uneventfully.Among the 48 patients, spontaneous abortion occurred in 7 patients (14.6%).Among the remaining 41 patients who continued on their gestation, 39 cases (95.1%) had full term deliveries, 2 cases (4.9%) terminated pregnancy with premature birth, 8 cases (19.5%) got different complications related to pregnancy, and 34 cases (82.9%) received cesarean sections.All the newborns survived, with an average weight of 3429.2 ±499.4 g.There were 2 cases (4.9%) of low birth weight.No asphyxia or congenital malformation was seen in all the newborns. Conclusions Total intravenous anesthesia can be applied to laparoscopic surgery smoothly for early pregnant women with tubal pregnancy.When surgery is indicated during pregnancy, maintenance of marternal oxygenation, perfusion and homeostasis with the minimum effective anesthetic dose will assure the best outcomes for the fetus.

Combined incisional ropivacaine infiltration and pulmonary recruitment manoeuvre for postoperative pain relief after diagnostic hysteroscopy and laparoscopy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Preoperative incisional local anaesthesia with ropivacaine is a common method of providing post-laparoscopy pain relief. The pulmonary recruitment manoeuvre also provides pain relief, but the combined effect of these two methods on pain following laparoscopic procedures has not been reported. We investigated the efficacy of combining local anaesthetic infiltration of ropivacaine with pulmonary recruitment manoeuvre on postoperative pain following diagnostic hysteroscopy and laparoscopy.</p><p><b>METHODS</b>This prospective, randomized, controlled study involved 60 patients divided into two groups (n = 30, each). Group 1 received 20 ml of 0.5% ropivacaine injected peri-incisionally preoperatively, with intra-abdominal carbon dioxide removed by passive deflation. Group 2 received 20 ml of 0.5% ropivacaine injected peri-incisionally with five manual inflations of the lungs with a positive-pressure ventilation of 40 cmH2O at the end of surgery. The last inflation was held for 5 seconds. The intensity of postoperative incisional and shoulder pain was evaluated using a numerical rating scale at 0, 2, 4, 8, 12, 24 and 48 hours postoperatively by an independent blinded anaesthesiologist. Tramadol was given postoperatively for analgesia.</p><p><b>RESULTS</b>Compared with group 1, incisional ropivacaine infiltration combined with pulmonary recruitment manoeuvre significantly reduced dynamic pain at 0 hour, 4 hours, and 24 hours postoperatively (4.1 ± 2.2 vs. 2.1 ± 1.9, P = 0.002; 2.7 ± 2.7 vs. 1.2 ± 1.3, P = 0.035; and 3.5 ± 2.1 vs. 2.1 ± 1.8, P = 0.03, respectively). Static incisional pain was significantly relieved at 0 hour, 2 hours, and 24 hours postoperatively (3.1 ± 1.7 vs. 1.6 ± 1.3, P = 0.001; 1.4 ± 1.3 vs. 0.5 ± 0.8, P = 0.012; and 2.3 ± 1.9 vs. 1.0 ± 1.5, P = 0.038, respectively). Group 2 had more patients without shoulder pain (P < 0.05) and fewer requiring tramadol (P < 0.05).</p><p><b>CONCLUSION</b>Ropivacaine with pulmonary recruitment manoeuvre provided simple and effective pain relief after diagnostic hysteroscopy and laparoscopy.</p>

Management of cervical intraepithelial neoplasia grade Ⅱ by loop electrosurgical excision procedure / 中国微创外科杂志

Objective To evaluate the effectiveness of loop electrosurgical excision procedure(LEEP) for the management of cervical intraepithelial neoplasia(CIN) grade Ⅱ. Methods A total of 28 patients were pathologically diagnosed as having CIN grade Ⅱ by colposcopic cervical biopsy.High-risk human papillomavirus(HPV) DNA testing showed positive results in 96.4% of the patients(27/28).The procedure was conducted under surface anesthesia.A loop electrode was used to cut through the cervical tissues,and then a square-shaped electrode or a small-sized loop electrode was utilized to complete the resection of lesions,including parts of the cervical canal.All the patients were followed postoperatively. Results The intraoperative blood loss was 0~20 ml,and the operation time was 5~10 min.Out of the 28 patients,postoperative abnormal vaginal bleeding was found in 3 patients.No other complications occurred.The resected tissues showed no obvious charring changes.The lesions of CIN completely disappeared in 15 patients(53.6%),subsided to grade Ⅰ in 5 patients,remained in grade Ⅱ in 5 patients,and progressed to grade Ⅲ in 3 patients.Follow-up examinations in the 28 patients for 6~24 months(mean,16 months) found no residual lesions or recurrence.The high-risk HPV DNA findings turned negative in 23 patients. Conclusions LEEP is a safe and effective procedure for the treatment of CIN grade Ⅱ,with advantages of little invasion,simplicity of performance,and no need of hospitalization.