Objective:The importance of a“second look”laparoscopy for adhesion formation after myomectomy by laparotomy in improving fertility is not clearly defined in our context.The aim of this study was to compare spontaneo...Objective:The importance of a“second look”laparoscopy for adhesion formation after myomectomy by laparotomy in improving fertility is not clearly defined in our context.The aim of this study was to compare spontaneous fertility after myomectomy by laparotomy between women who underwent a“second look”laparoscopy and those who did not.Methods:We conducted an analytical cross-sectional study with retrospective data collection from January 1,2008 to December 31,2015,comparing spontaneous fertility between patients who underwent“second-look”laparoscopy after myomectomy by laparotomy to those who did not.Firstly,data was collected from the records of patients included in the study.Secondly,through phone calls,informed consent for each participant was obtained after which inquiries were made regarding their fertility status.Results:After a period of 24 months,23 patients(47.9%)with“second look”laparoscopy conceived,compared to 37 patients(35.2%)without“second look”laparoscopy(p=0.136);and 24 patients(50.0%)with“second look”had term pregnancies compared to 39 patients(37.1%)without“second look”laparoscopy(p=0.134).Conclusion:Spontaneous fertility rates seemed to be improved after a“second look”laparoscopy,however,there was no statistically significant difference between spontaneous fertility rates obtained after myomectomy by laparotomy,irrespective of the fact that the patient had undergone a“second look”laparoscopy or not at Yaounde Gyneco-Obstetric and Pediatric Hospital.展开更多
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...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.展开更多
Objective:To study the degree of inflammatory stress response of laparoscopic myomectomy and abdominal surgery.Methods: Patients who underwent myomectomy in Maternal and Child Health Hospital of Dayi County between Ju...Objective:To study the degree of inflammatory stress response of laparoscopic myomectomy and abdominal surgery.Methods: Patients who underwent myomectomy in Maternal and Child Health Hospital of Dayi County between June 2014 and October 2017 were retrospectively analyzed, and according to different operation methods, they were divided into the laparoscopy group and the control group who underwent laparoscopic surgery and open surgery respectively. The contents of inflammatory factors and stress mediators in serum as well as the expression of inflammatory molecules and stress molecules in peripheral blood were measured before surgery and 1 d after surgery.Results: Compared with those of same group before surgery, serum TNF-α, sICAM1, sVCAM1, sTREM1, GH, Cor, C-P, FT4 and CRP levels as well as peripheral blood JAK2, STAT3, Notch2, Hes1, Nrf2, HO-1, MPO and FOXP3 expression intensity of both groups of patients were significantly higher after surgery, and serum TNF-α, sICAM1, sVCAM1, sTREM1, GH, Cor, C-P, FT4 and CRP levels as well as peripheral blood JAK2, STAT3, Notch2, Hes1, Nrf2, HO-1, MPO and FOXP3 expression intensity of laparoscopy group of patients after surgery were lower than those of control group. Conclusion: Compared with abdominal surgery, laparoscopic myomectomy can reduce the degree of postoperative inflammatory stress response.展开更多
Objective: To study the degree of inflammatory stress response of laparoscopic myomectomy and abdominal surgery. Methods: Patients who underwent myomectomy in Maternal and Child Health Hospital of Dayi County between ...Objective: To study the degree of inflammatory stress response of laparoscopic myomectomy and abdominal surgery. Methods: Patients who underwent myomectomy in Maternal and Child Health Hospital of Dayi County between June 2014 and October 2017 were retrospectively analyzed, and according to different operation methods, they were divided into the laparoscopy group and the control group who underwent laparoscopic surgery and open surgery respectively. The contents of inflammatory factors and stress mediators in serum as well as the expression of inflammatory molecules and stress molecules in peripheral blood were measured before surgery and 1 d after surgery. Results: Compared with those of same group before surgery, serum TNF-α, sICAM1, sVCAM1, sTREM1, GH, Cor, C-P, FT4 and CRP levels as well as peripheral blood JAK2, STAT3, Notch2, Hes1, Nrf2, HO-1, MPO and FOXP3 expression intensity of both groups of patients were significantly higher after surgery, and serum TNF-α, sICAM1, sVCAM1, sTREM1, GH, Cor, C-P, FT4 and CRP levels as well as peripheral blood JAK2, STAT3, Notch2, Hes1, Nrf2, HO-1, MPO and FOXP3 expression intensity of laparoscopy group of patients after surgery were lower than those of control group. Conclusion: Compared with abdominal surgery, laparoscopic myomectomy can reduce the degree of postoperative inflammatory stress response.展开更多
Background: Infertility is a global problem, but the highest prevalence is in low resource countries, particularly in sub-Saharan Africa where tubal damage following pelvic infection is the commonest cause. Objectives...Background: Infertility is a global problem, but the highest prevalence is in low resource countries, particularly in sub-Saharan Africa where tubal damage following pelvic infection is the commonest cause. Objectives: This study aimed to assess contribution of laparoscopy as a diagnostic and therapeutic tool in infertile women in our setting. Methods: A descriptive review of complete medical records of 208 women who underwent laparoscopy at the Gynaecology Unit of Yaoundé General Hospital from December 2007 to December 2012. Results: Two hundred and eight women were enrolled in this study. Mean age was 32.6 ± 11.25 years. Infertility was secondary in 71.6% of cases;125 (60.1%) women were married and 116 (55.8%) had a positive serology of Chlamydia trachomatis infection. The most frequent findings during diagnostic laparoscopy were: pelvic adhesions (83.7%), hydrosalpinx (21.6%), pyosalpinx (4.8%), perihepatic adhesions (25.5%), uterine fibromas (22.6%), pelvic endometriosis (13%) and ovarian abnormalities (10.1%). The surgical procedures during laparoscopy were: adhesiolysis (79.7%), tuboplasty (35.0%), salpingectomy (8.2%), ovarian cystectomy (5.8%) and myomectomy (1.9%). Three (1.4%) cases of uterine perforation and 1 (0.5%) case of laparoscopy conversion to laparotomy were observed. Conclusion: Diagnostic laparoscopy revealed that tubal lesions and pelvic adhesions were still the major causes of female infertility in developing countries. Adhesiolysis and tuboplasty were the most frequently performed surgical procedures during laparoscopy. Therefore, training in endoscopic surgery should be regarded as an important issue in developing countries.展开更多
To editor:Uterine myomas are the most common benign tumors of the female reproductive system,with a reported prevalence of 0.1%to 3.9%during pregnancy.1 Among these,10%to 30%cause severe pregnancy complications includ...To editor:Uterine myomas are the most common benign tumors of the female reproductive system,with a reported prevalence of 0.1%to 3.9%during pregnancy.1 Among these,10%to 30%cause severe pregnancy complications including miscarriage,placenta previa,fetal growth restriction,preterm labor,fetal malpresentations,and postpartum hemorrhage related to the number,volume,and location of myomas.2,3 Uterine myomas are usually asymptomatic but occasionally may cause acute abdominal pain secondary to pedunculated myoma torsion or compression of urinary and gastrointestinal organs.展开更多
Background:Uncontained morcellation of myoma during laparoscopic surgery has been discouraged because of unknown malignancy.Even the safety of contained morcellation has been questioned because muscle cells have been ...Background:Uncontained morcellation of myoma during laparoscopic surgery has been discouraged because of unknown malignancy.Even the safety of contained morcellation has been questioned because muscle cells have been detected in washings obtained during laparoscopic procedures.The possibility of myoma cell dissemination has been observed in open abdominal surgery,even after hysterectomy.Thus myomectomy would be unsafe from an oncological point of view,regardless of surgical approach.Methods:This is an observational cohort study involving 30 patients who underwent open abdominal myomectomy.Peritoneal abdominal washings were obtained two times during the open abdominal myomectomy:before uterus incision and after the myomectomy itself.Cytological,cell block,and immunohistochemical evaluations were performed.Results:All washings obtained immediately after abdominal peritoneal cavity opening were negative for fibroid cells.Both the first and second washings were free of myoma cells.Cytologic evaluation did not reveal any smooth muscle cells.The results of desmin and smooth muscle actin staining,performed on the pre-and postmyomectomy samples,were negative.Conclusion:Our results demonstrated,for the first time to our knowledge,that there is no dissemination of myoma cells during conservative abdominal surgery.It could represent an additional oncological safety.Further data are needed.展开更多
文摘Objective:The importance of a“second look”laparoscopy for adhesion formation after myomectomy by laparotomy in improving fertility is not clearly defined in our context.The aim of this study was to compare spontaneous fertility after myomectomy by laparotomy between women who underwent a“second look”laparoscopy and those who did not.Methods:We conducted an analytical cross-sectional study with retrospective data collection from January 1,2008 to December 31,2015,comparing spontaneous fertility between patients who underwent“second-look”laparoscopy after myomectomy by laparotomy to those who did not.Firstly,data was collected from the records of patients included in the study.Secondly,through phone calls,informed consent for each participant was obtained after which inquiries were made regarding their fertility status.Results:After a period of 24 months,23 patients(47.9%)with“second look”laparoscopy conceived,compared to 37 patients(35.2%)without“second look”laparoscopy(p=0.136);and 24 patients(50.0%)with“second look”had term pregnancies compared to 39 patients(37.1%)without“second look”laparoscopy(p=0.134).Conclusion:Spontaneous fertility rates seemed to be improved after a“second look”laparoscopy,however,there was no statistically significant difference between spontaneous fertility rates obtained after myomectomy by laparotomy,irrespective of the fact that the patient had undergone a“second look”laparoscopy or not at Yaounde Gyneco-Obstetric and Pediatric Hospital.
文摘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.
文摘Objective:To study the degree of inflammatory stress response of laparoscopic myomectomy and abdominal surgery.Methods: Patients who underwent myomectomy in Maternal and Child Health Hospital of Dayi County between June 2014 and October 2017 were retrospectively analyzed, and according to different operation methods, they were divided into the laparoscopy group and the control group who underwent laparoscopic surgery and open surgery respectively. The contents of inflammatory factors and stress mediators in serum as well as the expression of inflammatory molecules and stress molecules in peripheral blood were measured before surgery and 1 d after surgery.Results: Compared with those of same group before surgery, serum TNF-α, sICAM1, sVCAM1, sTREM1, GH, Cor, C-P, FT4 and CRP levels as well as peripheral blood JAK2, STAT3, Notch2, Hes1, Nrf2, HO-1, MPO and FOXP3 expression intensity of both groups of patients were significantly higher after surgery, and serum TNF-α, sICAM1, sVCAM1, sTREM1, GH, Cor, C-P, FT4 and CRP levels as well as peripheral blood JAK2, STAT3, Notch2, Hes1, Nrf2, HO-1, MPO and FOXP3 expression intensity of laparoscopy group of patients after surgery were lower than those of control group. Conclusion: Compared with abdominal surgery, laparoscopic myomectomy can reduce the degree of postoperative inflammatory stress response.
文摘Objective: To study the degree of inflammatory stress response of laparoscopic myomectomy and abdominal surgery. Methods: Patients who underwent myomectomy in Maternal and Child Health Hospital of Dayi County between June 2014 and October 2017 were retrospectively analyzed, and according to different operation methods, they were divided into the laparoscopy group and the control group who underwent laparoscopic surgery and open surgery respectively. The contents of inflammatory factors and stress mediators in serum as well as the expression of inflammatory molecules and stress molecules in peripheral blood were measured before surgery and 1 d after surgery. Results: Compared with those of same group before surgery, serum TNF-α, sICAM1, sVCAM1, sTREM1, GH, Cor, C-P, FT4 and CRP levels as well as peripheral blood JAK2, STAT3, Notch2, Hes1, Nrf2, HO-1, MPO and FOXP3 expression intensity of both groups of patients were significantly higher after surgery, and serum TNF-α, sICAM1, sVCAM1, sTREM1, GH, Cor, C-P, FT4 and CRP levels as well as peripheral blood JAK2, STAT3, Notch2, Hes1, Nrf2, HO-1, MPO and FOXP3 expression intensity of laparoscopy group of patients after surgery were lower than those of control group. Conclusion: Compared with abdominal surgery, laparoscopic myomectomy can reduce the degree of postoperative inflammatory stress response.
文摘Background: Infertility is a global problem, but the highest prevalence is in low resource countries, particularly in sub-Saharan Africa where tubal damage following pelvic infection is the commonest cause. Objectives: This study aimed to assess contribution of laparoscopy as a diagnostic and therapeutic tool in infertile women in our setting. Methods: A descriptive review of complete medical records of 208 women who underwent laparoscopy at the Gynaecology Unit of Yaoundé General Hospital from December 2007 to December 2012. Results: Two hundred and eight women were enrolled in this study. Mean age was 32.6 ± 11.25 years. Infertility was secondary in 71.6% of cases;125 (60.1%) women were married and 116 (55.8%) had a positive serology of Chlamydia trachomatis infection. The most frequent findings during diagnostic laparoscopy were: pelvic adhesions (83.7%), hydrosalpinx (21.6%), pyosalpinx (4.8%), perihepatic adhesions (25.5%), uterine fibromas (22.6%), pelvic endometriosis (13%) and ovarian abnormalities (10.1%). The surgical procedures during laparoscopy were: adhesiolysis (79.7%), tuboplasty (35.0%), salpingectomy (8.2%), ovarian cystectomy (5.8%) and myomectomy (1.9%). Three (1.4%) cases of uterine perforation and 1 (0.5%) case of laparoscopy conversion to laparotomy were observed. Conclusion: Diagnostic laparoscopy revealed that tubal lesions and pelvic adhesions were still the major causes of female infertility in developing countries. Adhesiolysis and tuboplasty were the most frequently performed surgical procedures during laparoscopy. Therefore, training in endoscopic surgery should be regarded as an important issue in developing countries.
文摘To editor:Uterine myomas are the most common benign tumors of the female reproductive system,with a reported prevalence of 0.1%to 3.9%during pregnancy.1 Among these,10%to 30%cause severe pregnancy complications including miscarriage,placenta previa,fetal growth restriction,preterm labor,fetal malpresentations,and postpartum hemorrhage related to the number,volume,and location of myomas.2,3 Uterine myomas are usually asymptomatic but occasionally may cause acute abdominal pain secondary to pedunculated myoma torsion or compression of urinary and gastrointestinal organs.
文摘Background:Uncontained morcellation of myoma during laparoscopic surgery has been discouraged because of unknown malignancy.Even the safety of contained morcellation has been questioned because muscle cells have been detected in washings obtained during laparoscopic procedures.The possibility of myoma cell dissemination has been observed in open abdominal surgery,even after hysterectomy.Thus myomectomy would be unsafe from an oncological point of view,regardless of surgical approach.Methods:This is an observational cohort study involving 30 patients who underwent open abdominal myomectomy.Peritoneal abdominal washings were obtained two times during the open abdominal myomectomy:before uterus incision and after the myomectomy itself.Cytological,cell block,and immunohistochemical evaluations were performed.Results:All washings obtained immediately after abdominal peritoneal cavity opening were negative for fibroid cells.Both the first and second washings were free of myoma cells.Cytologic evaluation did not reveal any smooth muscle cells.The results of desmin and smooth muscle actin staining,performed on the pre-and postmyomectomy samples,were negative.Conclusion:Our results demonstrated,for the first time to our knowledge,that there is no dissemination of myoma cells during conservative abdominal surgery.It could represent an additional oncological safety.Further data are needed.
