不影响宫腔形态的肌壁间子宫肌瘤对体外受精-胚胎移植妊娠结局的影响

目的 探讨不影响宫腔形态的肌壁间子宫肌瘤对体外受精-胚胎移植(IVF-ET)妊娠结局的影响及随访观察.方法 选取于生殖中心行IVF-ET,不孕合并超声检查示不影响宫腔形态的肌壁间子宫肌瘤患者91例,共行胚胎移植100个周期(观察组),抽取同期行IVF-ET治疗的单纯输卵管性不孕不合并子宫肌瘤患者100例(对照组).对两组的一般情况、控制性超排卵情况、体外受精参数和妊娠结局进行回顾性对照分析.结果 两组的基本情况差异无统计学意义.观察组与对照组的胚胎种植率(26.7% vs 30.5%)、临床妊娠率(48.0% vs 51.0%)、自然流产率(20.8% vs 31.4%)、活产率(32.0% vs 28.0%)、早产率(9.4% vs 7.1%)差异无统计学意义(P>0.05).随访示观察组和对照组的剖宫产率为81.3%(26/32)和71.4%(20/28),差异无统计学意义(P>0.05).观察组剖宫产术中行肌瘤剔除者超过半数(11/20),剔除的肌瘤大小为2~5 cm,无出现术中大出血.结论 不影响宫腔形态的肌壁间子宫肌瘤对IVF-ET临床妊娠结局无明显不良影响.     

基于3D-TVS子宫内膜面积成像评估宫腔粘连的新方法

【目的】探讨一种基于经阴道三维超声（3D-TVS）下子宫内膜面积成像评估宫腔粘连（IUA）的新方法。【方法】回顾性分析2017年1月至2018年1月因可疑IUA或者不孕症在我院行宫腔镜检查或者手术的121例患者病史，术前3D-TVS子宫内膜面积大小及手术资料。按照宫腔镜下AFS分期标准对IUA患者进行分期，ROC曲线分析3D-TVS下子宫内膜面积诊断IUA的准确性，Logistic回归分析IUA的影响因素。【结果】根据3D-TVS子宫内膜面积诊断IUA，ROC曲线下面积为0.839，界值点为4.23cm2，灵敏度为0.86，特异度为0.74，诊断准确率76.03%。根据宫腔镜下IUA的AFS分期，进一步计算不同程度IUA的3D-TVS子宫内膜面积界值点，具体为：轻度IUA（4.02，4.23］cm2，中度IUA（3.23，4.02］cm2，重度IUA≤3.23cm2。Logistic回归分析显示：流产孕周每增加一周，IUA的发生率就增加30.6%［OR=1.306，95%CI（1.112-1.532），P=0.001］，3D-TVS子宫内膜面积每减少1cm2，IUA的发生率就增加18.9%［OR=0.189，95%CI（0.079-0.450），P<0.001］。【结论】3D-TVS下子宫内膜面积可以作为一种简单、快速的诊段IUA的指标，并在一定程度上反映IUA的严重程度。     

子宫内膜异位症生育指数与rAFS分期在IVF中的预测价值

【目的】 探讨子宫内膜异位症生育指数(EFI)与rAFS分期对体外受精胚胎移植(IVFET)的累积妊娠结局的预测价值?【方法】 回顾性分析2008年1月至2011年12月109例143个周期行腹腔镜手术治疗后到本生殖中心行IVFET的子宫内膜异位症(EMs)因素不孕患者的病史?手术资料及妊娠结局?按照rAFS的分期标准对EMs患者进分期,按照EFI的评分标准计算EFI,利用ROC曲线与多水平模型分别比较EFI评分和rAFS分期对IVF累积妊娠结局的影响? 【结果】 (1)EFI评分预测IVF累积妊娠结局的ROC曲线下面积为0.644,大于机会参考线下面积(P < 0.05);诊断界值点为6分,特异性为0.62,敏感性为0.61;AFS分期预测IVF累积妊娠结局的ROC曲线下面积为0.415(P > 0.05),不具有诊断意义?(2)根据ROC曲线诊断界值点为6分,将患者以6分为界,分别比较4分与5分?≤5分与≥6分?6分与≥7分的累积妊娠率的差异?EFI评分为4分(n = 6)?5分(n = 28)的患者,累积妊娠率为40.0%,44.5%,差异无统计学意义(P > 0.05);EFI评分为≤5分(n = 71),≥6分(n = 72)的患者,总累积妊娠率有统计学差异(38.2% vs. 60.6%,P = 0.005);EFI评分6分(n = 36), ≥7分(n = 37)的患者,累积妊娠率为61.8%, 59.5%,差异无统计学意义(P > 0.05);<3分的患者,有 17个IVF周期,累积妊娠率为25.0%?rAFS分期为Ⅰ期(n = 28)?Ⅱ期(n = 12)?Ⅲ期(n = 39)?IV期(n = 64)的患者,累积妊娠率无统计学差异(P = 0.163)? 【结论】 子宫内膜异位症生育指数(EFI)可以有效的预测 EMs患者腹腔镜术后IVF累积妊娠结局,≥6分的患者累积妊娠率有明显升高,为EMs患者腹腔术后IVF临床诊疗提供了重要的参考依据?未发现rAFS分期对EMs患者IVFET后的妊娠结局有预测价值?     

评估妇科良性疾病腹腔镜术前机械性肠道准备的必要性#br#

Objective?To evaluate the necessity of mechanical bowel preparation (MBP) before benign gynecologic laparoscopic surgeries. Methods?This was a prospective, single-blind, randomized controlled study. A total of 160 patients were randomly divided into two groups: the study group had a low-residue diet the day before operation, the control group had a MBP in the day before operation (polyethylene glycol electrolyte powder, added 2 000 ml warm boiled water in it, and drunk it from 14:00). A visual analogue scale (VAS) score was used to evaluate gastrointestinal discomfort, a five-point scale was used to evaluate the quality of the surgical field. Results?The VAS scores of the abdominal bloating, anal irritation and willingness to try another preparation in the control group [0(0, 4) points; 0(0, 4) points; 5(0, 8) points] were significantly increased than those of the study group [0(0, 1) points; 0(0, 1) points; 2(0, 5) points] (P<0.05) on preoperative day. The proportions of “good” or “excellent” in the large bowel preparation, the small bowel preparation and the convenience of bowel handling were statistically higher in the control group (36.25%, 47.50% and 41.25%) than those of the study group (16.25%, 23.75% and 21.25%) (P<0.05), but there were no statistical differences in the proportions of “good” or “excellent” in the visual field at start and end and the visualization of posterior cul de sac in the study group (66.25%, 70.00%, 63.75%) compared with the control group (77.50%, 76.25%, 76.25%) (P>0.05). Conclusion?It is not necessary to perform routine mechanical bowl preparation before benign gynecologic laparoscopic surgeries.