经宫腹腔术联合GnRH-a治疗子宫内膜异位综合征不孕效果及对患者性激素及血清5-LOX、LXA4变化影响

目的:探讨促性腺激素释放激素(GnRH-a)治疗子宫内膜异位综合征不孕患者宫腹腔镜术后激素水平及对血清5-脂氧化酶(5-LOX)、脂氧素A4(LXA4)影响。方法:选取2017年6月—2018年12月经本院诊治的子宫内膜异位综合征且不孕行宫-腹腔镜术后患者55例。根据患者意愿分为对照组(n=25)和观察组(n=30),对照组给予醋酸甲羟孕酮片药物治疗,观察组给予GnRH-a治疗。比较两组有效率、血清性激素及5-LOX、LXA4水平、视觉模拟评分法(VAS)评分。结果:术后1年内观察组总复发率(3.3%)低于对照组(28.0%),术后1年内妊娠率(63.3%)、2年累积临床妊娠率(76.7%)均高于对照组(28.0%、48.0%)(均P<0.05);术后生育能力观察组与对照组分别为6.03%和2.26%,两组危险度比值为2.67;两组术后雌二醇(E2)、促黄体生成素(LH)、卵泡刺激素(FSH)水平均低于术前且观察组低于对照组,LXA4、5-LOX水平均高于术前且观察组高于对照组(P<0.05);观察组患者性交痛、慢性盆腔痛、痛经评分值低于对照组(P<0.05)。结论:GnRH-a可更有利于患者术后血清5-LOX、LXA4表达提高及性激素水平调节,从而降低不孕患者术后复发率,提高妊娠率。

子宫内膜异位症合并不孕患者双镜术后妊娠的危险因素分析

目的探讨子宫内膜异位症合并不孕患者双镜术后妊娠的危险因素。方法选取2013年6月至2015年8月巴中市中心医院收治的320例子宫内膜异位症合并不孕患者为研究对象,患者入院后均施行宫-腹腔镜术治疗,统计纳入患者术后成功妊娠率,采用单因素和多因素Logistic回归分析法分析子宫内膜异位症合并不孕患者双镜术后妊娠的独立影响因素。结果该研究随访至术后24个月,术后随访期间320例患者中共有220例妊娠,妊娠率68.75%;单因素分析显示妊娠组年龄≥35岁、不孕类型为原发型、不孕年限≥3年、有腹部手术史、子宫内膜异位症分期(r-AFS)分期为Ⅲ~Ⅳ期、病理分型为深部浸润型、未进行促排卵治疗所占百分比较未妊娠组明显低,差异均具有统计学意义(χ~2/Z值分别为12.35、5.82、9.80、14.40、22.96、29.32、13.05,均P<0.05);多因素Logistic回归分析结果显示年龄≥35岁(OR=2.10,P=0.01,95%CI:1.25~3.58)、不孕类型为原发型(OR=1.53,P=0.01,95%CI:1.00~3.31)、不孕年限≥3年(OR=2.02,P=0.03,95%CI:1.05~3.53)、r-AFS分期为Ⅲ~Ⅳ期(OR=2.89,P=0.01,95%CI:1.01~3.98)、促排卵治疗(OR=4.91,P=0.01,95%CI:2.10~6.19)是影响子宫内膜异位症合并不孕患者双镜术后妊娠率的独立相关因素。结论年龄、不孕类型、不孕年限、r-AFS分期及促排卵治疗是子宫内膜异位症合并不孕患者双镜术后妊娠的重要影响因素,临床工作中可据此采取相关措施以提高患者术后妊娠率。

Sigmoid colon endometriosis treated with laparoscopy-assisted sigmoidectomy:Significance of preoperative diagnosis

We present a female patient with sigmoid colon endometriosis who was diagnosed correctly preoperatively and underwent minimally invasive surgery. She was admitted to our hospital with rectal bleeding and constipation. We performed several workups. Colonoscopy and endoscopic ultrasonography showed sigmoid colon stenosis caused by submucosal tumor, and magnetic resonance imaging revealed a sigmoid colon tumor displaying signal hy- pointensity on both T1- and T2-weighted imaging. However, colonoscopic ultrasonography-assisted needle aspiration biopsy could not specify tumor characteristics. From these examinations, the lesion was diagnosed as sigmoid colon endometriosis and laparoscopy-assisted sigmoidectomy was performed. Pathological diagnosis from the resected specimen was identical to preoperative diagnosis, i.e., colonic endometriosis. Since differential diagnosis of intestinal endometriosis seems difficult, a cautious preoperative diagnosis is required to select treatments including minimally invasive surgery.

观察宫腹腔镜剖宫产疤痕妊娠病灶切除术、子宫修补术联合治疗Ⅱ型剖宫产疤痕妊娠(CSP)患者的临床效果

观察宫-腹腔镜剖宫产疤痕妊娠病灶切除术、子宫修补术联合治疗II型剖宫产疤痕妊娠患者的临床效果。方法:研究时间段为2019年7月-2020年11月,选择在我院进行II型剖宫产疤痕妊娠治疗的50例患者作为研究对象,按照基偶数的形式分为两组,每组各25名病例。要求对照组接受宫腔镜剖宫产疤痕妊娠病灶切除术治疗进行治疗,观察组接受宫-腹腔镜剖宫产疤痕妊娠病灶切除术联合子宫修补术进行治疗,对两组患者进行跟踪分析,分析项目包括其临床医学指标和发生并发症的概率。结果:研究发现,观察组的恢复情况要比对照组好,表现在:对照组的月经出血量大于观察组;对照组的并发症发生概率大于观察组,(观察组发生并发症概率为8%,对照组发生并发症概率为32%)(P<0.05)。结论:II型剖宫产疤痕妊娠患者应用宫-腹腔镜剖宫产疤痕妊娠病灶切除术和子宫修补术联合起来的治疗效果良好,应该广泛应用在医学治疗中。

Clinical Efficacy and Safety Analysis of Laparoscopic- assisted Vaginal Surgery and Laparoscopic-alone Surgery in Treatment of Endometrial Cancer

Objective： Assess clinical efficacy and safety analysis of laparoscopic-assisted vaginal surgery and laparoscopic-alone surgery in treatment of endometrial cancer. Methods： select 76 cases of endometrial cancer patients, divided into two groups, 40 in laparoscopic-alone group and 36 in laparoscopic-assisted group, and compare operation time, intraoperative blood loss, intraoperative complications, postoperative complications, lymph node number, anal exhaust time, indwelling catheter days and hospitalization days by group. Result： compared with laparoscopic-alone surgery, laparoscopic-assisted vaginal surgery has certain advantages in reducing intraoperative blood loss, intraoperative and postoperative complications, anal exhaust time, indwelling catheter days and hospitalization days. Discussion： laparoscopic-assisted vaginal surgery is a relatively safe, effective and good economic benefit surgical method in treatment of endometrial cancer.

LAPAROSCOPIC MYOMECTOMY

Objective. To investigate the indications, surgical techniques and complications of laparoscopic myomectomy. Materials and methods. A retrospective study was carried out in 74 patients with fibroids >3cm from March, 1995 until May,2000 at PUMC Hospital. Indications for surgery were symptomatic fibroids（ 20 cases） , mainly pain or urine frequency； progressively increasing fibroid size (7 cases)； coexistent adnexal pathology（ 26 cases） and infertility（ 21 cases） . Results. The number of fibroids of each patient varied from 1 to 4 with single fibroid of 62 cases (83.7％ ).The fibroids were located in anterior wall (30 cases), posterior wall (23 cases) and fundus (21 cases). A total of 93 fibroids were removed from these patients including 16 intramural fibroids and 77 subserous fibroids. The size of dominant fibroids ranged from 3～ 8 cm (mean 4.8 cm). In 19 cases (25.6％ ),the uterine wall was sutured in one layer. Mean duration of operation was 73 minutes and mean blood loss was 82 ml. Longer operating time and more blood loss were observed in patients with fibroids≥ 4cm than those with fibroids < 4cm. The difference was statistically significant (P< 0.05). Mean postoperative hospital stay was 3.2 days and overall complication rate was 1.4％ . The average postoperative follow- up period was 22 months (1～ 62 months). All the patients with symptoms showed remission of their complaints at 2- month follow- up. Recurrence of fibroid occurred in 1 case 1 year after initial operation and second laparoscopic myomectomy was given to her successfully. Five patients became pregnant. The pregnancy was uneventful and proceeded to selective caesarean section at term pregnancy in 4 cases. One miscarriage occured at 8 weeks in the 5th case. No adhesions at myomectomy site were found in these 5 patients. Conclusions. Our study suggests the feasibility of laparoscopic myomectomy in selected patients, which leads to effectiveness, low complication rate and satisfactory remission of symptoms. Further study on recurrence and fertility must be continued.

Laparoscopic surgery in endometrial carcinoma staging operation:analysis of 39 cases

Objective:The purpose of our study was to investigate the feasibility and short-term therapeutic effects of laparoscopic staging operation in women with endometrial carcinoma.Methods:We analyzed 86 patients with endometrial carcinoma in PLA general hospital between 2006 and 2009 retrospectively.Thirty-nine patients were performed laparoscopic modified radical hysterectomy plus systemic retroperitoneal lymphadenectomy.Forty-seven patients received traditional abdominal radical hysterectomy plus systemic retroperitoneal lymphadenectomy.We compared the operation time,blood loss,number of lymph nodes retrieved,time for restoration of gastrointestinal function,postoperative complications and morbidity,the incidence of wound infection,the length of hospital stay,and hospital charges.Results:There was no significant deviation between the two groups in age,clinical stage,and pathology.We found that there was no significant deviation between the two groups in the number of lymph nodes retrieved,postoperative complications,the rate of wound infection or hospital charge(P > 0.05).The laparoscopic group had an advantage in blood loss,time for restoration of gastrointestinal function,time for postoperative hospital stay(P < 0.05).Conclusion:Laparoscopic surgery,as a primary surgical intervention,seems to be a safe and feasible option especially in patients with early endometrial cancer.