Molecular classification of endometrial carcinoma on endometrial biopsy: an early prognostic value to guide personalized treatment.

OBJECTIVE: Molecular features are essential for estimating the risk of recurrence and impacting overall survival in patients with endometrial cancer. Additionally, the surgical procedure itself could be personalized based on the molecular characteristics of the tumor. This study aims to assess the feasibility of obtaining reliable molecular classification status from biopsy specimens collected during hysteroscopy to better modulate the appropriate surgical treatment. METHODS: This monocentric, retrospective, observational study was conducted on 106 patients who underwent a biopsy procedure followed by radical surgery for endometrial cancer, with concurrent molecular investigation. The molecular classification was determined through immunohistochemical staining for p53 and mismatch repair proteins, along with gene sequencing for POLE. RESULTS: Overall, 106 patients underwent molecular investigation, which was finally achieved on 99 patients (93.4%). Among these, the molecular analysis was conducted in 71 patients (67%) on the pre-operative endometrial biopsy and on the final uterine specimen in 28 patients (26.4%). Most of the endometrial biopsies were performed using Bettocchi hysteroscopy (66%). Molecular analysis was not possible in seven patients (6.6%), with six cases due to sample inadequacy and one case attributed to intra-mucosal carcinoma. The molecular results showed that the copy number low sub-group was the most common, and five cases of 'multiple classifiers' were observed in the low-risk category. CONCLUSION: Our experience in obtaining molecular information from biopsy samples underscores the feasibility and efficacy of this technique, even in small tissue samples. This capability helps define the prognostic group of patients, facilitates timely decision-making, and develops a personalized strategy for each patient.

Oncological safety of hysteroscopy in endometrial cancer.

OBJECTIVE: It has been suggested that the manipulation of neoplastic tissue during hysteroscopy may lead to dissemination of tumor cells into the peritoneal cavity and worsen prognosis and overall survival. The goal of this study was to assess the oncological safety comparing hysteroscopy to Pipelle blind biopsy in the presurgical diagnosis of patients with endometrial cancer. METHODS: We performed a retrospective multicentric study among patients who had received primary surgical treatment for endometrial cancer. A multivariate statistical analysis model was used to compare relapse and survival rates in patients who had been evaluated preoperatively either by hysteroscopy or Pipelle biopsy. The relapse rate, disease-free survival, and overall survival were assessed as the main outcomes. The histological type, tumor size, myometrial invasion, International Federation of Gynecology and Obstetrics (FIGO) stage, surgical approach, use of a uterine manipulator, and adjuvant treatment were also included in the analysis. RESULTS: A total of 1731 women from 15 centers were included: 1044 in the hysteroscopy group and 687 in the Pipelle sampling group. 225 patients relapsed during the 10 year follow-up period: 139 (13.3%) in the hysteroscopy group and 86 (12.4%) in the Pipelle sampling group. There is no evidence of an association between the use of hysteroscopy as a diagnostic method and relapse rate (HR 1.24, 95% CI 0.92 to 1.66; p=0.16), lower disease-free survival (HR 1.23, 95% CI 0.92 to 1.66; p=0.15), or overall survival (HR 0.95, 95% CI 0.70 to 1.29; p=0.76). CONCLUSION: Hysteroscopy is a safe diagnostic method for patients with endometrial cancer with no impact on oncological outcomes when compared with sampling by Pipelle.

Construction and evaluation of a nomogram prediction model for the intrauterine adhesions risk factor after hysteroscopic surgery for subumcosal myoma of uterus / 中国医师进修杂志

Objective:To analyze the risk factors of intrauterine adhesions in patients after hysteroscopic surgery for subumcosal myoma of uterus, and to construct and evaluate a nomogram prediction model.Methods:The clinical data of 322 patients underwent hysteroscopic surgery for subumcosal myoma of uterus in Dongguan Maternal and Child Health Hospital from January 2017 to December 2020 were collected. The univariate analysis and multivariate Logistic regression were used to analyze the factors affecting the occurrence of intrauterine adhesions, according to the analysis results, R software was used to construct a nomogram prediction model that affected the occurrence of intrauterine adhesions after hysteroscopic surgery for subumcosal myoma of uterus, and the H-L fit curve and the area under the curve were used to evaluate the effectiveness and discrimination of the model.Results:Through a 1-year follow-up, it was found that 47 patients had intrauterine adhesions (adhesions group), accounting for 14.60%; another 275 patients was enrolled in non-adhesions group. The results of univariate analysis showed that combined pelvic inflammatory disease, pregnancy times, history of curettage, combined uterine fibroids, and serumtransforming growth factor (TGF)-β1 level were risk factors that affected the occurrence of intrauterine adhesions ( P<0.05). The results of multivariate Logistic regression analysis showed that serum TGF-β1 level, pelvic inflammatory disease, history of curettage and uterine fibroids were independent risk factors that affected the occurrence of intrauterine adhesions ( P<0.05). The nomogram prediction model was established with the results of multivariate Logistic regression analysis, and the discrimination of the nomogram model was evaluated, the results showed that the area under the curve was 0.854, and the sensitivity and specificity were 91.50% and 70.50%, respectively. The validity of the model (H-L fit curve) was evaluated and the results showed that χ2 = 7.12, P = 0.413. Conclusions:Serum TGF-β1 level, combined with pelvic inflammatory disease, history of curettage, combined with uterine fibroids are independent risk factors that affect the occurrence of uterine adhesions after hysteroscopic surgery for subumcosal myoma of uterus. The constructed nomogram prediction model has relatively good effectiveness and discrimination. It can be used as an effective predictive tool for early clinical intervention.

Clinical effect and influencing factors of focused ultrasound ablation surgery combined with suction curettage for the treatment of mass-type cesarean scar pregnancy / 中华妇产科杂志

Objective:To investigate the clinical effect of focused ultrasound ablation surgery (FUAS) combined with suction curettage for mass-type cesarean scar pregnancy (CSP) and to analyze the influencing factors of vaginal bleeding and readmission.Methods:From January 2014 to December 2020, 88 patients with mass-type CSP were treated by FUAS combined with suction curettage in the Third Xiangya Hospital of Central South University. The clinical results and the influencing factors of bleeding and readmission for mass-type CSP were analyzed.Results:All the patients underwent one time FUAS treatment successfully. Immediately after FUAS treatment, color Doppler ultrasound showed obvious necrosis and no perfusion area in all lesions, and the blood flow in the mass-type CSP tissue significantly decreased. The median volume of blood loss in the procedure was 20 ml (range: 5-950 ml). Thirteen patients (15%, 13/88) had vaginal bleeding≥200 ml, and 15 patients (17%, 15/88) were hospitalized again. The average time for menstruation recovery was (28±8) days (range: 18-66 days). The average time needed for serum human chorionic gonadotropin-beta subunit to return to normal levels was (22±6) days (range: 7-59 days). The risk of large vaginal bleeding of patients were related to the blood supply of the mass ( OR=5.280, 95% CI: 1.335-20.858, P=0.018) and the largest diameter of the mass ( OR=1.060, 95% CI: 1.010-1.120, P=0.030). The risk of readmission were related to the largest diameter of the mass ( OR=1.055, 95% CI: 1.005-1.108, P=0.030) and the depth of the uterus cavity ( OR=1.583, 95% CI: 1.015-2.471, P=0.043). No serious complications such as intestinal and nerve injury occurred during and after FUAS treatment. Conclusions:FUAS combined with suction curettage is safe and effective in treating patients with mass-type CSP through this preliminary study. The volume of vaginal bleeding are associated with the blood supply of the mass and the largest diameter of the mass, the risk of readmission are related to the largest diameter of the mass and the depth of the uterus cavity.

Clinical study of Chaichuan Tongren Mixture supplemented with hysteroscopic recanalization for the patients with tubal obstructive infertility of liver depression and qi stagnation type / 国际中医中药杂志

Objective:To evaluate the efficacy of Chaichuan Tongren Mixture supplemented with hysteroscopic recanalization in the treatment of tubal obstructive infertility of liver depression and qi stagnation type.Methods:A total of 60 patients with tubal obstructive infertility of liver depression and qi stagnation type who met the inclusion criteria were selected, between August 2018 and June 2020, and they were divided into the observation group with 31 cases and the control group with 29 cases, according to the random number table method. The control group was treated with hysteroscopic recanalization, while the observation group was given Chaichuan Tongren Mixture on the basis of the control group. Both groups were treated for 4 months and followed up for 12 months. TCM syndromes were scored before and after treatment, and prostaglandin E 2 (PGE 2) was detected by fully automatic biochemical analyzer and levels of TNF-α, CRP and IL-6 were measured by ELISA. The tubal patency of patients after treatment was observed, the pregnancy status was recorded after the end of follow-up and the clinical efficacy was evaluated. Results:The total effective rate was 96.77% in the observation group and that in the control group was 75.86% ( χ2=4.01, P<0.01). The scores of breast distending pain, irregular menstruation, dark purple menstrual flow and lumbosacral pain in the observation group after treatment were significantly lower than those in the control group ( t values were 17.69, 21.67, 20.89, 14.67, 18.20, respectively, all Ps<0.001). After treatment, the levels of serum PGE 2, TNF-α, CRP, and IL-6 were significantly lower in the observation group than those in the control group [(65.31±6.73) ng/L vs. (87.10±8.85) ng/L, t=10.78; (6.90±0.71) ng/L vs. (11.35±1.23) ng/L, t=17.30; (2.47±0.25) mg/L vs. (5.10±0.52) mg/L, t=25.23; (12.38±1.26) ng/L vs. (30.16±3.15) ng/L, t=29.05] ( P<0.01). After treatment, there was statistical significance in the total effective rate of tubal patency of 96.8% (30/31) in the observation group compared to 79.3% (23/29) in the control group ( χ2=4.43, P<0.01). At the end of follow-up, the pregnancy rate was 71.0% (22/31) in the observation group and 44.8% (13/29) in the control group, and the difference was statistically significant ( χ2=4.21, P<0.01). Conclusion:The Chaichuan Tongren Mixture supplemented with hysteroscopic recanalization can reduce the levels of inflammatory mediators and increase the pregnancy rate of patients with tubal obstructive infertility of liver depression and qi stagnation type.

Impact of hysteroscopy on course of disease in high-risk endometrial carcinoma.

OBJECTIVE: Previous studies have investigated the impact of preoperative hysteroscopy on the staging and survival of predominantly grade 1 endometrial cancers. We sought to evaluate the effect of hysteroscopy on the peritoneal spread of tumor cells and disease course in a large series of patients with high-risk endometrial cancer. METHODS: Patients who underwent hysterectomy for grade 3 endometrial carcinoma on final surgical pathology at the Mayo Clinic in Rochester, MN between January 2009 to June 2016 were included, noting hysteroscopy within 6 months from surgery. Intra-peritoneal disease was defined as any positive cytology OR adnexal invasion OR stage IV. The presence of intra-peritoneal disease OR peritoneal recurrence within 2 years from surgery was defined as peritoneal dissemination. Cox proportional hazards models were fit to evaluate associations between hysteroscopy exposure and progression within 5 years following surgery. RESULTS: Among 831 patients, 133 underwent hysteroscopy. There was no difference in age, body mass index, ASA ≥3, or serous histology between patients who did or did not undergo hysteroscopy. Advanced stage disease (III/IV) was less common among patients who underwent hysteroscopy (30.1% vs 43.8%, P=0.003). No difference was observed between those with vs without hysteroscopy in the rate of positive cytology (22.0% vs 29.7%, P=0.09), stage IV (16.5% vs 21.9%, P=0.16), intra-peritoneal disease (28.6% vs 36.1%, P=0.09), or peritoneal dissemination (30.8% vs 39.3%, P=0.06). On stratifying by stage, hysteroscopy did not increase the risk of progression (HR 1.06, 95% CI 0.59 to 1.92 for stage I/II; HR 0.96, 95% CI 0.62 to 1.48 for stage III/IV). CONCLUSION: In this retrospective study of grade 3 endometrial cancer, we did not observe any significant association between pre-operative hysteroscopy and the incidence of positive cytology, peritoneal disease, peritoneal dissemination, or cancer progression.

Safety and Assisted Reproductive Technology Outcomes of Hysteroscopic Tubal Microinserts Versus Laparoscopic Proximal Tubal Occlusion or Salpingectomy for Hydrosalpinges Treatment.

OBJECTIVE: This study sought to answer the following question: What are the complications and assisted reproductive technology outcomes among women with hydrosalpinges managed by hysteroscopic microinsert tubal occlusion compared with women with hydrosalpinges managed by laparoscopic proximal tubal occlusion or salpingectomy? METHODS: This was a retrospective cohort study conducted from January 2009 to December 2014 at two academic, tertiary care, in vitro fertilization centres in Toronto, Ontario. All patients (n = 52) who underwent hysteroscopic tubal occlusion for hydrosalpinges were identified. Patients who proceeded with embryo transfer cycles after hysteroscopic microinsert (n = 33) were further age matched to a cohort of patients who underwent embryo transfer after laparoscopic proximal tubal occlusion or salpingectomy (n = 33). Main outcome measures were clinical pregnancy rate per patient and per embryo transfer cycle. RESULTS: Among 33 patients, there were 39 fresh and 37 frozen embryo transfer cycles in the hysteroscopic group (group A); among 33 patients in the laparoscopic group (group B), there were 42 fresh and 29 frozen embryo transfer cycles. The cumulative clinical pregnancy rate in group A and group B was similar (66.7% vs. 69.7%, respectively; P = 0.8). The clinical pregnancy rate per embryo transfer cycle was also similar in both groups (28.9% in group A vs. 32.4% in group B; P = 0.6). There were two incidents of ectopic pregnancy in the laparoscopic group and no ectopic pregnancy in the hysteroscopic group. There were three major complications: tubo-ovarian abscess, distal migration of the coil after microinsert placement, and an acute abdomen following the hysteroscopic procedure. CONCLUSION: Pregnancy outcomes after hysteroscopic placement of a microinsert for hydrosalpinx management before embryo transfer were comparable to those following laparoscopic proximal tubal occlusion or salpingectomy. However, caution is advised regarding microinsert placement for hydrosalpinges before proceeding with assisted reproductive technology.

Sentinel lymph node mapping in endometrial cancer: performance of hysteroscopic injection of tracers.

OBJECTIVE: To report on the performance of hysteroscopic injection of tracers (indocyanine green (ICG) and technetium-99m (Tc-99m)) for sentinel lymph node (SLN) mapping in endometrial cancer. METHODS: Single-center retrospective evaluation of consecutive patients who underwent SLN mapping following hysteroscopic peritumoral injection of tracer. Detection rate (overall/bilateral/aortic) diagnostic accuracy, and oncologic outcomes were evaluated. RESULTS: A total of 221 procedures met the inclusion criteria. Mean patient age was 60 (range 28-84) years and mean body mass index was 26.9 (range 15-47) kg/m2 . In 164 cases (70.9%) mapping was performed laparoscopically. The overall detection rate of the technique was 94.1% (208/221 patients). Bilateral pelvic mapping was found in 62.5% of cases with at least one SLN detected and was more frequent using ICG than with Tc-99m (73.8% vs 53.3%; p<0.001). In 47.6% of cases SLNs mapped in both pelvic and aortic nodes, and in five cases (2.4%) only in the aortic area. In eight patients (3.8%) SLNs were found in aberrant (parametrial/presacral) areas. Mean number of detected SLNs was 3.7 (range 1-8). In 51.9% of cases at least one node other than SLNs was removed. Twenty-six patients (12.5%) had nodal involvement: 12 (46.2%) macrometastases, six (23.1%) micrometastases, and eight (30.7%) isolated tumor cells. In 12 cases (46.8%) the aortic area was involved. Overall, 6/221 (2.7%) patients had isolated para-aortic nodes. Three false-negative results were found, all in the Tc-99m group. All had isolated aortic metastases. Overall sensitivity was 88.5% (95% CI 71.7 to 100.0) and overall negative predictive value was 96.5% (95% CI 86.8 to 100.0). There were 10 (4.8%) recurrences: five abdominal/distant, four vaginal, and one nodal (in the aortic area following a unilateral mapping plus side-specific pelvic lymphadenectomy). Most recurrences (9/10 cases) were patients in whom a completion lymphadenectomy was performed. No deaths were reported after a mean follow-up of 47.7 months. CONCLUSIONS: Hysteroscopic injection of tracers for SLN mapping in endometrial cancer is as accurate as cervical injection with a higher detection rate in the aortic area. ICG improves the bilateral detection rate. Adding lymphadenectomy to SLN mapping does not reduce the risk of relapse.

Effect of Shengxuening tablets combined with ethinylestradiol and cyproterone acetate on thickness of endometrium and hemoglobin levels in patients with endometrial polyps for transcervical resection of polyp / 国际中医中药杂志

Objective To investigate the effects of Shengxuening tablets combined with ethinylestradiol and cycloproterone acetate on endometrial thickness and hemoglobin level in patients with endometrial polyps for transcervical resection of polyp. Methods A total of 150 patients with hysteroscopic endometrial polypectomy were randomly divided into three groups, 50 in each group. The control group was treated with hysteroscopy endometrial polyp electrotomy, while the western medicine group was treated with ethinylestradiol and cycloprogesterone acetate tablets on the basis of the control group, and the combined group was treated with Shengxuening tablets on the basis of the western medicine group. The menstrual volume, endometrial thickness and hemoglobin levels were observed before treatment, at 3 month, 6 month and 12 month after treatment, and the clinical efficacy and recurrence during follow-up were evaluated. Results The total effective rate was 98.0％(49/50) in the combined group, 96.0％ (48/50) in the western medicine group, 86.0％ (43/50) in the control group. The total effective rate in the combined group and the western medicine group was significantly higher than that in the control group (χ2=6.643, P=0.036). The menstrual volume (F=28.096, 49.096, 33.303), endometrial thickness (F=11.214, 20.265, 63.947) in the three groups were significantly different after treatment (P<0.01), and which in the combined group were significantly lower than those in the western medicine group, menstrual volume at 36,12 after treatment (t value were 4.747, 2.244, 4.489, P<0.01); endometrial thickness at 3, 6, 12 month after treatment (t value were 3.293, 3.356, 5.293, P<0.01); there were significant differences in hemoglobin levels in the three groups (F=11.002, 8.662, 8.958, P<0.01), and which in the combined group was significantly higher than that in the western medicine group at 3,6,12 month after treatment (t value were 2.722, 2.074, 2.028, P<0.05). During the follow-up period, 2 cases (4.1％) recurred in the combined group, 3 cases (6.3％) recurred in the western medicine group and 9 cases (20.9％) recurred in the control group. The recurrence rate in the combined group or the western medicine group was significantly lower than that in the control group (χ2=6.775, P=0.034). There was no significant difference in the recurrence rate in the combined group and the western medicine group (χ2=0.211, P=0.646). Conclusions The Ethynestradiol and Cyproterone acetate combined with Shengxuening tablets could improve the curative effect, reduce menstrual volume and endometrial thickness, increase hemoglobin level and reduce recurrence rate in patients with endometrial polyps for transcervical resection of polyp.

A clinical study of Guizhi-Fuling pill combined with conventional therapy for the patients with oviduct obstructive infertility / 国际中医中药杂志

Objective In order to evaluate the clinical curative effect of Guizhi-Fuling pill combined with conventional therapy for the patients with oviduct obstructive infertility.Methods In this study,102 patients with oviduct obstructive infertility (OO1) that accorded with the inclusion criteria were randomly divided into two groups according to the order of treatment.During the study,a total of 5 patients were lost in the two groups,and so 49 in the treatment group and 48 in the control group completed the protocol.The control group was given fallopian tube recanalization under the hysteroscopy,and the treatment group was given oral Guizhi-Fuling pill at day 2 after surgery on the basis of the control group treatment.Both groups were observed for 6 months.Before and after treatment,TCM symptom score was conducted,and IL-6 level was determined by radioimmunoassay;the uterine fallopian tube was examined after the 6th month of treatment,and pregnancy rate was observed and recorded.Results After treatment,abdominal pain degree (0.6 ± 0.1 vs.1.3 ± 0.1,t=3.612),the low back pain (0.9 ± 0.2 vs.1.6 ± 0.2,t=2.553),abdominal distension (0.5 ± 0.0 vs.1.0 ± 0.8,t=2.364),menstrual blood clots (0.5 ± 0.1 vs.1.0 ± 0.1,t=2.331) in the treatment group were significantly lower than those in the control group (Ps＜0.05).After treatment,the rate of oviduct patency was 75.5％ (37/49) in thetreatment group,50.0％ (24/48) in the control group,and the comparison difference between the two groups was statistically significant (x2=8.075,P=0.044).After 6 months of treatment,the pregnancy rate of the treatment group was 63.3％ (31/49),and that of the control group was 37.5％ (18/48),the difference of pregnancy rate between the two groups was statistically significant (x2=6.724,P=0.035).After treatment,serum IL-6 (31.04 ± 2.47 ng/ml vs.42.71 ± 2.52 ng/ml,t=7.593) in the treatment group was signicantly lower than the control group (P＜0.05).Conelusions Guizhi-Fuling pill combined with conventional therapy can reduce IL-6 level,promote fallopian tube recanalization,improve the intrauterine pregnancy rate,and improve the clinical symptoms of OOI patients.

Ultrasound-guided hysteroscopy in the treatment of uterine fibroids / 中国基层医药

Objective@#To investigate the clinical value of ultrasonography-guided hysteroscopy in the treatment of uterine fibroids.@*Methods@#From October 2015 to June 2016, 96 patients with uterine fibroids in Laiyang Central Hospital were selected as study objects, and they were randomly divided into two groups, with 48 cases in each group.The control group underwent conventional hysteroscopic myomectomy.The observation group was guided by ultrasonography to guide the hysteroscopic myoma stripping under the control group.The operation time, intraoperative blood loss and postoperative hospitalization were observed.The postoperative recurrence and postoperative success rate of pregnancy were compared between the two groups.@*Results@#The operation time in the observation group was (40.6±3.8)min, which was shorter than (59.8±8.5)min in the control group (t=10.566, P<0.05). The intraoperative blood loss in the observation group was (100.5±2.9)mL, which was less than (156.8±5.9)mL in the control group (t=59.332, P<0.05). The hospitalization time of the observation group was (4.2±0.2)d, which was shorter than (6.5±0.3)d in the control group (t=44.195, P<0.05). The recurrence rate of the observation group (4.17%) was lower than that of the control group (31.25%) (χ2=10.293, P<0.05). The postoperative pregnancy rate of the observation group (68.75%) was higher than that of the control group (22.92%) (χ2=18.374, P<0.05).@*Conclusion@#Ultrasound-guided hysteroscopy is effective in the treatment of intrauterine uterine fibroids with less trauma and faster postoperative recovery.It can significantly reduce the probability of recurrence and improve the pregnancy rate.

Diagnostic value of hysteroscopy in determining the etiology of postmenopausal intrauterine fluid collection / 中华老年医学杂志

Objective To investigate the clinical value of hysteroscopy in helping identify the etiology of intrauterine fluid collection in postmenopausal women.Methods One hundred and thirtyfour postmenopausal women with intrauterine fluid collection,detected via transvaginal sonography,were admitted in the department of gynecology and obstetrics at Beijing ChaoYang Hospital from May 2014 to October 2016.All clinical data were retrospectively analyzed.All patients underwent hysteroscopy and biopsy of the endometrium.The results of hysteroscopy were analyzed against biopsy results.Results Hysteroscopy revealed that 116 of the 134 cases had uterine fluid(86.6％).Based on hysteroscopy results,44 (37.9 ％) had endometritis,10 (8.6 ％) had atrophic endometritis,5 (4.3 ％) had endometrial carcinoma,and 7(6.0 ％)had endometrial polyps,but the case numbers and rates for these conditions from microscopic examination were39 (33.6％),15 (12.9％),6 (5.2％),and 7 (6.0 ％),respectively.When microscopic examination was used as the gold standard,the sensitivities and specificities of hysteroscopy in the diagnosis of endometritis,atrophic endometritis,endometrial cancer and endometrial polyps were 82.0 ％ and 85.7 ％,66.7 ％ and 97.1％,80.0 ％ and 98.2 ％,and 100.0％ and 97.3％,respectively.The diagnostic coincidence rates were 84.6％,93.2％,94.4％ and 97.4％,respectively.Conclusions Postmenopausal women with intrauterine fluid collection shown on transvaginal sonography should receive hysteroscopy for early detection of endometrial lesions.

Diagnostic value of transvaginal three-dimensional ultrasound in intrauterine adhesion / 重庆医学

Objective To analyze the diagnostic value of transvaginal three-dimensional ultrasound in intrauterine adhesion.Methods The data in 75 patients with intrauterine adhesion confirmed by hysteroscopy surgery and conducting transvaginal twodimensional and three-dimensional ultrasound examination in this hospital from November 2014 to November 2016 were retrospectively analyzed.Results The diagnostic accuracy rate of the three-dimensional transvaginal ultrasound for diagnosing intrauterine adhesion reached 87.7 ％,which of two-dimensional ultrasound reached 69.2 ％;the accuracy rates of transvaginal two-dimensional ultrasound for detecting mild,middle and severe intrauterine adhesion were 56.7％,76.9％ and 88.9％ respectively,while which of transvaginal three-dimensional ultrasound were 76.7 ％,96.2 ％ and 100.0 ％ respectively;the accuracy rates of transvaginal two-dimensional ultrasound for detecting peripheral,central and mixed intrauterine adhesion were 66.7％,76.7％ and 54.5％ respectively,while which of transvaginal three-dimensional ultrasound were 83.3％,88.7％ and 100.0％ respectively;the accuracy rate of three-dimensional transvaginal ultrasound was significantly superior to that of transvaginal two-dimensional ultrasound,the difference was statistically significant (P＜0.05).Conclusion Compared with transvaginal two-dimensional ultrasound,transvaginal three-dimensional ultrasound is more accuracy in diagnosing intrauterine adhesion and can provide more information for clinical doctors.

Clinical value of transvaginal color doppler ultrasonography and hysteroscopy uteroscope in the diagnosis of endometrial lesions in postmenopausal women / 中国基层医药

Objective To investigate the clinical value of transvaginal color doppler ultrasonography and hysteroscopy uteroscope in the diagnosis of endometrial lesions in postmenopausal women.Methods A total of 135 postmenopausal women with endometrial lesions were selected in this research.The patients were divided into observation group(67 patients)and control group(68 patients)according to random number table.The observation group adopted transvaginal color doppler ultrasonography and hysteroscopy uteroscope,the control group adopted transvaginal color doppler ultrasonography.The patients' treatment effect in the two groups were collected and analyzed.Results Of 67 patients in the observation group,there were 4 cases of endometrial polyp,23 cases of endometrial cyst,25 cases of adenomyomatous endometrial polyp and 15 cases of endometrial cancer,the diagnostic accuracy was significantly higher than that of the control group,the differences were statistically significant(x2=9.129,9.131,9.128,9.132,all P<0.05).In the observation group,the diagnostic accuracy of the obvious characteristics of internal granular internal echo,sparse punctate flow endometrial and uterine wall line than before obviously pathological lesions were better than those in the control group,the differences were statistically significant(x2=8.964,9.045,8.980,9.024,all P<0.05).Conclusion Transvaginal color doppler ultrasonography and hysteroscopy uteroscope has better effect in diagnosis of endometrial lesions in postmenopausal women,which is worthy of promotion.

Comparative Study between Monopolar Electrodes and Bipolar Electrodes in Hysteroscopic Surgery.

BACKGROUND: The hysteroscopic surgery has become a simple and safe technique, with the use of small hysteroscopes and bipolar energy with trained surgeons, which can prevent abortions and probably increase fertility. AIM: The study was conducted to evaluate the outcomes after hysteroscopic surgery by using uninopolar or bipolar electrodes. SETTING AND DESIGN: At the department of Obstetrics and Gynaecology, Qena university hospital and is a prospective non randomized clinical study. MATERIALS AND METHODS: One hundred fifty patients who included in this study were non randomly classified into two groups; one for hysteroscopic surgery by using bipolar electrode and the second group using unipolar electrode. Operative complications; bleeding, perforation, fluid over load and hyponatraemia were recorded. Also, operative time and hospital stay were included. RESULTS: There were no statistically significant differences between both groups in patient's characteristics, ultrasono-graphic findings, serum sodium levels before surgical interference, perforation and intraoperative bleeding. The fluid overload was significantly higher in unipolar group (p value= 0.03), postoperative hyponatraemia was significantly marked in unipolar group (p<0.05) and the changes of the levels of serum sodium in unipolar group in comparison to bipolar group were significantly different (p = 0.01). The mean operative time was significantly less in the bipolar group when compared to the unipolar group (p = 0.01) and the hospital stay was obviously less for patients of the bipolar group in comparison to unipolar group (p=0.04). CONCLUSION: Operative hysteroscopy using bipolar electrodes associated with significant decrease in hyponatraemia, operative time and postoperative hospital stay. So, it is safe and effective method when compared to using the unipolar electrodes.

The clinical research of different surgical methods under hysteroscopes for endometrial polyps infertility / 中国医师进修杂志

Objective To explore the clinical effectiveness of transcervical resection of polyps (TCRP) under hysteroscopes and dilatation and curettage in treatment for endometrial polyps infertility.Methods Ninety patients with endometrial polyps infertility from October 2010 to August 2012 were enrolled in this study.In them,45 patients were treated with TCRP under hysteroscopes (TCRP group),45 patients were treated with dilatation and curettage (dilatation and curettage group).Patients were followed up for 1 year,menstrual blood volume and endometrial thickness in ovulatory before operation and after operation for 3,6 and 12 months were recorded and compared between two groups.While the recurrence rate after operation for 6,12 months and 1-year pregnancy rate were also recorded and compared between two groups.Results The menstrual blood volume and endometrial thickness in ovulatory before operation between two groups had no significant difference (P ＞ 0.05).The menstrual blood volume after operation for 3,6 and 12 months in TCRP group was (125.2 ±56.4),(154.0 ±72.3) and (189.8 ±96.6) ml,respectively.While in dilatation and curettage group was (215.3 ± 87.8),(267.5 ± 98.4) and (297.5 ± 125.6) ml.There were significant differences (P ＜ 0.05 or ＜ 0.01).The endometrial thickness in ovulatory after operation for 3,6 and 12 months in TCRP group was significantly lower than that in dilatation and curettage group (P ＜ 0.05 or ＜ 0.01).The recurrence rate after operation for 6,12 months and 1-year pregnancy rate in TCRP group was 4.4％ (2/45),8.9％ (4/45)and 20.0％ (9/45) ; in dilatation and curettage group was 8.9％ (4/45),35.6％(16/45) and 26.7％ (12/45).The recurrence rate after operation for 12 months in TCRP group was significantly higher than that in dilatation and curettage group (P ＜0.01).Conclusions The prospective efficacy of TCRP under hysteroscopes in treatment of endometrial polyps infertility is better than dilatation and curettage.It is one of better methods and worthy to spread.

Prevention of re-adhesion after high dose estradiol valerate and hysteroscopy regular inspection after separation of severe intrauterine adhesions / 中国医师进修杂志

Objective To investigate the prevention of re-adhesion after high dose estradiol valerate and hysteroscopy regular inspection after separation of severe intrauterine adhesions.Methods A total of 97 severe intrauterine adhesions patients after transcervical resection of adhesions were divided into group A,B,C:group A placed intrauterine device and oral intook progynova 1 mg/d after 2 days of surgery,3 times/d,for 3 months; group B placed intrauterine device and oral intook progynova 3 mg/d after 2 days of surgery,3 times/d,for 3 months; group C with the same treatment as group B with further hystemscopy regular inspection every month.Regular follow-up data were collected in the following 3 months to compare endometrial thickness,re-adhesion occurrence and treatment effect in different groups.Results After 3 months of treatment,endometrial thickness of group B and group C was higher than that in group A [(0.83 ± 0.23),(0.99 ± 0.28) cm vs.(0.54 ± 0.18) cm],group C was higher than group B,and there were significant differences (P＜ 0.05).The effective rate in group B and group C was higher than that in group A [75.00％(24/32),90.32％(28/31) vs.61.76％(21/34)],group C was higher than group B,and there were significant differences (P＜ 0.05).The occurrence rate of re-adhesion in group B and group C was lower than that in group A [21.88％(7/32),9.68％(3/31)vs.38.23％(13/34)],group C was higher than group B,and there were significant differences (P ＜ 0.05).Conclusion The prevention of re-adhesion after high dose estradiol valerate and hysteroscopy regular inspection is effective and superior.

The diagnosis value of transvaginal ultrasound combined with hysterosalpinography on previous cesarean scar defect / 中国医师进修杂志

Objective To investigate the clinical practice value of transvaginal ultrasound (TVU) combined with hysterosalpinography (HSG) in diagnosis of previous cesarean scar defect (PCSD).Methods Forty-two patients with colporrhagia,algomenorrhea or infertility after cesarean section were examined by TVU,HSG and hysteroscope.The results were compared among TVU,HSG and TVU combined with HSG.Results Among the 42 patients,21 patients were diagnosed PCSD by hysteroscope.The sensitivity of TVU was 66.7％ (14/21),specificity was 95.2％ (20/21),positive predictive value was 14/15,negative predictive value was 74.1％ (20/27).The sensitivity of HSG was 95.2％ (20/21),specificity was 100.0％ (21/21),positive predictive value was 100.0％(20/20),negative predictive value was 95.5％(21/22).The sensitivity of TVU combined with HSG was 95.2％(20/21),the sensitivity of TVU combined with HSG was significantly higher than TVU,there was statistical difference (P ＜0.05).Conclusions Compared with TVU,the sensitivity of TVU combined with HSG is increased markedly.TVU combined with HSG is a feasible clinical diagnostic method.

Clinical efficacy and safety of hysteroscopy surgery combined with methotrexate for treating the patients with cesarean scar pregnancy / 中国医师进修杂志

Objective To investigate the clinical efficacy and safety of hysteroscopy surgery combined with methotrexate (MTX) for treating the patients with cesarean scar pregnancy(CSP).Methods The clinical data of 64 patients with CSP were retrospectively analyzed.The patients were divided into observation group (46 cases) and control group (18 cases) according to treatment methods,the control group was given the therapy of local pregnancy intracapsular MTX combined with uterine curettage,and the observation group was given the therapy of local pregnancy intracapsular MTX combined with lesions removed surgery by hysteroscopy.The intraoperative blood Ioss,epistrophy time of β-human chorionic gonadotrophin (hCG),hospitalization time,clinical efficacy of the two groups were observed.Follow-up for 6 months the menstruation of the two groups was observed.Results The total effective rate in observation group was significantly higher than that in control group [100.0％ (46/46) vs.66.7％ (12/18),x2 =16.920,P ＜ 0.01].The intraoperative blood loss,epistrophy time of β-hCG and hospitalization time in observation group were significantly lower than those in control group [(35.46 ± 11.63) ml vs.(176.78 ± 57.96) ml,(21.04 ± 6.79)d vs.(39.65 ± 12.79) d,(13.89 ±4.63) d vs.(26.82 ±8.94) d,P＜0.01].The observation group had a successful surgery and no complications.In the control group,4 cases occurred uterine curettage intraoperative bleeding,2 cases underwent open lesion resection and then were forced to line hysterectomy.The rate of menstruation in observation group after operation 30-39 d was significantly higher than that in control group [84.8％ (39/46) vs.25.0％ (4/16),P ＜ 0.01].Conclusions Hysteroscopy surgery combined with MTX for treating the patients with CSP has exact clinical effect.It is safe and reliable,and is worthy of promotion and application.