绝经后子宫出血宫腔镜检查429例结果分析

目的分析绝经后子宫出血的病因,提供临床参考。方法对2002年8月至2008年5月间因绝经后子宫出血就诊的429例患者宫腔镜检查结果进行回顾性总结。结果宫腔镜诊断为绝经后宫腔118例,属非器质性病变,占27．5％。良性病变,包括子宫内膜息肉、内膜炎、宫颈管息肉、粘膜下肌瘤和宫颈管炎共计226例,占52．7％。恶性病变61例（占14.2％）,病理证实57例,准确率达93．4％。结论绝经后子宫出血中非器质性和良性病变占大多数．恶性病变占少数。宫腔镜对及早明确子宫出血的原因非常有帮助。     

Incidence cumulative d’hystérectomies chez les femmes ayant subi une résection hystéroscopique de l’endomètre

Objective: to measure the cumulative failure rate following a hysteroscopic endometrial ablation for menorrhagia, and assess the satisfaction level of the treated women who did not require hysterectomy within five years of their initial endometrial ablation.Methods: retrospective study of 218 patients in whom endometrial ablation was performed by five gynaecologists at the Centre Hospitalier affilié Universitaire-de Québec—Pavillon St-Sacrement, between 1991 and 1997. The information was documented by phone interview and by chart review in 188 women.Results: the cumulative failure rates, assessed by the need to perform a hysterectomy after one, two, three, four and five years were 5.9, 8.3, 12.3, 17.5 and 18.5 percent, respectively. The satisfaction level in 157 women who did not require a hysterectomy was 86.6 percent. Among studied factors (age, parity, previous hormonal treatment, gynaecologist, indication for endometrial ablation, pathological findings and surgical complications), age was the only variable which was significantly associated with the risk of subsequent hysterectomy. The cumulative incidences of hysterectomy at 60 months were 53.5 and 11.6 percent in women below and above the age of 35 years, respectively.Conclusion: hysteroscopic endometrial ablation is an effective treatment for menorrhagia. This study allows the clinician to inform patients better about the relative success rate of this procedure, according to their age.     

Clinical application of three-dimensional transvaginal ultrasonography in the diagnosis of intrauterine adhesions

ObjectiveThe present study aimed to evaluate the diagnostic accuracy of three-dimensional transvaginal ultrasonography (3D-TVS) for intrauterine adhesions (IUA).MethodsWe performed a retrospective cohort study. A total of 500 women aged 19 to 46 years with uterine lesions who received treatment from the Department of Obstetrics and Gynecology were enrolled. Endometrial 3D imaging was conducted to obtain the display plane and 3D-TVS parameters. Patients also underwent hysteroscopy for a definitive diagnosis.ResultsFor diagnosing IUA, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy of 3D-TVS were 98.8%, 90.8%, 91.4%, 98.7%, and 94.8%, respectively. For diagnosing a submucosal myoma, the sensitivity, specificity, PPV, NPV, and overall accuracy of 3D-TVS were 88.2%, 97.9%, 88.2%, 97.9%, and 96.4%, respectively. For diagnosing endometrial polyps, the sensitivity, specificity, PPV, NPV, and overall accuracy of 3D-TVS were 94.7%, 96.8%, 92.9%, 97.7%, and 96.2%, respectively.ConclusionsBefore hysteroscopy, 3D-TVS, as a method of screening, has great value for comparing differences before and after treatment, and for evaluating therapeutic effects.     

妇科内镜手术培训与考核体系在住培中期测评的价值研究

目的 对妇科内镜手术培训与考核体系(gynecological endoscopic surgical education and assessment,GESEA)在妇产科住院医师规范化培训(简称住陪)中进行了中期测评,评价GESEA在试点单位中的应用有效性及培训次数的价值.方法 纳入2018—2019年进入上海交通...     

宫腔镜在月经减少及闭经中的诊治价值探讨

目的 评价宫腔镜在月经减少及闭经中的诊断价值及治疗情况;方法回顾性分析102例月经减少及闭经患者宫腔镜检查情况及治疗情况,与其他诊断方法作对比.结果 月经减少及闭经者,多由于内膜有不同程度的损伤,宫腔镜在诊断方面较其他诊断方法有明显的优势.结论 宫腔镜可作为月经减少及闭经患者的常规检查方法.     

腹腔镜单用与宫腹腔镜联合应用在治疗不孕症中的对比分析

目的 探讨宫腹腔镜联合应用在诊治女性不孕症中的价值和治疗后卵巢储备功能变化情况,并与腹腔镜单用诊治进行比较.方法 收集该科2010年1月～2011年12月治疗的238例不孕症患者的临床资料,分为宫腹腔镜联合治疗组(观察组)和腹腔镜单用治疗组(对照组),观察对比两组病因构成,并对患者治疗后妊娠情况及卵巢储备功能进行随访.结果 两组患者都以输卵管病变和盆腔病变为多见,观察组宫腔粘连、子宫肌瘤、纵隔子宫、子宫内膜息肉的检查阳性率明显高于对照组,两者比较差异有显著性(P＜0.05).治疗后通过随访,观察组妊娠88例,妊娠率达61.54％,对照组妊娠46例,妊娠率为48.42％,两组比较差异有显著性(P＜0.05).各组患者血清FSH、LH和E2水平在治疗后1个月较治疗前和治疗后其他时间结果差异有显著性(P＜0.05),两组间血清FSH、LH和E2水平差异无显著性(P＞0.05)；两组间治疗前后卵巢截面积、PSV和EDV比较差异无显著性(P＞0.05),各组治疗后1个月的卵巢截面积、EDV和PSV参数较治疗前和治疗后其他时间结果差异有显著性(P＜0.05).结论 联合应用宫腹腔镜是诊治女性不孕症的有效方法,能够直观、准确、全面地对盆腔及宫腔进行检查,根据病因采取有针对性的治疗,能够提高妊娠率,具有临床推广应用价值.     

宫腔镜治疗结核引起的重度宫腔粘连14例分析

目的 探讨宫腔镜治疗由子宫内膜结核引起的重度宫腔粘连(IUA)的安全性和有效性。方法 回顾性分析1998年1月～2004年5月间该院行经宫颈宫腔粘连切除术(TCRA)治疗由结核所致的14例重度IUA患者的临床资料。结果 全部手术均在B超或B超联合腹腔镜监护下完成，术中出现子宫穿孔2例，术后患者宫腔形态基本恢复正常。平均随访38个月，所有患者均再次形成重度IUA，无1例妊娠。结论 宫腔镜治疗IUA是安全的，但由子宫内膜结核引起的重度IUA，经TCRA及相关治疗后预后很差。     

156例宫腔镜下子宫纵隔切除术后的生殖预后

目的探究和分析宫腔镜下子宫纵隔切除术(TCRS)的手术指征及生殖预后。方法采用回顾性研究方法,选择北京市平谷区医院及首都医科大学附属北京天坛医院2013年1月至2019年12月接收的156例纵隔子宫患者为主要对象,所有患者均实施宫腔镜下子宫纵隔切除术治疗,术后随访2~6年,分析患者术后妊娠及分娩结局。结果(1)25例有生育要求的患者行预防性切除子宫纵隔,术后22例(88.0%)妊娠,其中16例分娩(64.0%),6例流产(24.0%);(2)术中无1例发生子宫穿孔,出血及经尿道前列腺电切(TURP)综合征。术后无妊娠期子宫破裂发生。发生宫腔粘连5例(3.2%),均为轻微粘连;(3)不孕率、自然流产、稽留流产率分别由术前的21.9%、22.8%、29.8%降至8.4%、10.8%、7.2%,足月分娩率及活产率由术前的1.8%、2.6%升至66.3%、69.9%,术后妊娠率72.5%,手术前后比较差异有统计学意义(P<0.05)。结论对于诊断为子宫纵隔并且有生育要求的患者,建议进行预防性切除子宫纵隔;宫腔镜下子宫纵隔切除手术(TCRS)微创、安全、有效,能够明显改善其妊娠结局。     

宫腔镜子宫中隔切除术后妊娠相关因素分析

目的分析子宫中隔对妊娠结局的影响,探讨宫腔镜下子宫中隔切除术(TCRS)后妊娠的相关因素。方法回顾性分析行宫腔镜下TCRS并有生育要求的随访资料完整的125例患者的临床资料,分析手术前后妊娠结局差异以及术后妊娠相关因素。结果 TCRS手术前、后自然流产率分别为70.40%和19.39%,活产率分别为10.40%和72.45%,差异有统计学意义(P0.05)。患者年龄≥35岁者与35者比较,前者术后自然流产率更高,活产率更低,差异均有统计学意义。术前不同的宫腔操作次数、自然流产次数和中隔长度等术后妊娠比较差异均无统计学意义。结论宫腔镜下子宫中隔切除术可明显改善妊娠结局。术后妊娠受患者年龄的影响,而与术前自然流产次数、中隔状态及术后治疗方式等可能无关。