冷刀分离宫腔粘连术后妊娠结局相关因素分析

目的:探讨冷刀分离宫腔粘连术后影响妊娠结局的相关因素。方法:回顾分析158例行冷刀分离宫腔粘连术患者的临床资料,对可能影响妊娠结局的相关因素进行单因素和多因素Logistic回归分析,包括年龄、病程、宫腔操作次数、术前月经、术后月经、是否曾电切、粘连范围、粘连类型、粘连程度、防粘连措施、再粘连与否。结果:158例患者行冷刀分离粘连后,月经改善率80.3%,总妊娠率为60.1%,活产率为55.8%。病程、术后月经、粘连范围、粘连类型、粘连程度、再粘连与妊娠结局有关(P0.05),年龄、宫腔操作次数、术前月经、曾电切、防粘连装置与妊娠结局无关(P0.05)。多因素Logistic回归分析显示,再粘连是影响妊娠结局的独立危险因素。结论:冷刀作为一种对子宫内膜和宫腔环境损伤小的手术方式,可能成为有生育要求的宫腔粘连患者的首要选择。病程、术后月经、粘连范围、粘连类型、粘连程度、再粘连是影响冷刀分离粘连术后妊娠结局的主要因素。     

Prenatal factors affecting intrauterine growth retardation

Intrauterine growth retardation (IUGR), like postnatal growth retardation, involves skeletal and soft tissues. It is important to distinguish between depletion of soft tissues and stunting of linear skeletal growth, not only in older infants and children, but also in newborn infants. There are three main types of IUGR. To diagnose all three types involves much more than simply obtaining an individual's weight in relation to his or her age, as is now the widely accepted practice in newborn infants. Standards of intrauterine growth should not include growth-retarded newborn infants, insofar as it is possible to exclude them. Tables and graphs of intrauterine growth based on representative populations of newborn infants are apt to be a mixture of unknown numbers of normally grown and growth-retarded fetuses. The suggestion is put forward that standards of intrauterine growth should be based on newborn infants who have not been subjected to known growth-retarding influences prenatally. The diagnosis of intrauterine growth retardation prenatally by ultrasonic techniques has not reached the degree of reliability and validity that is needed for the routine detection of all fetuses with severe intrauterine growth retardation. Prenatal measurements made by ultrasound still require confirmation postnatally by appropriate measurements of infants at birth. The epidemiology, diagnosis, and postnatal courses of newborn infants with severe types of IUGR are discussed.     

Sonographic imaging of intrauterine adhesions

Hysterosalpingography and hysteroscopy are the diagnostic modalities most commonly used to evaluate and follow intrauterine adhesions (Asherman syndrome). Three patients with intrauterine adhesions are presented. These adhesions were visualized with sonography and appeared as dense intrauterine lines. These lines disappeared after hysteroscopic lysis of the adhesions. The present results indicate that sonography may alert the clinician to the presence of intrauterine adhesions.     

Prognostic factors for women with Stage 1 ovarian cancer with or without adhesions

OBJECTIVE: To identify those prognostic factors in women with Stage 1 epithelial ovarian cancer that predict survival. METHODS: A population-based cohort study was conducted which included all newly diagnosed ovarian cancer patients treated initially with surgery from 1996-1998 in Ontario, Canada (N = 1,341). We abstracted charts from hospitals and cancer centres and used hospital and billing claims databases. Cox survival analysis was used to model the association between prognostic factors (including patient characteristics, surgical findings, pathologic findings and subsequent treatment) and survival for those with Stage 1 ovarian cancer. RESULTS: 327 women had Stage 1 or 2 ovarian cancer (where Stage 2 was based on adhesions alone). Prognostic factors that had significant, unadjusted, association with survival were patient age, presence or absence of adhesions, grade, and surface involvement. The multivariable model that best described survival included premenopausal age group (HR 0.32, 95% CI, 0.18-0.55), poor differentiation (HR 2.17, 95% CI, 1.33-3.51), and surface capsule involvement (HR 2.97, 95% CI, 1.59-5.55). A lack of influence of treatment modality stands in contrast to the literature. CONCLUSIONS: Our dataset confirmed that poor grade and surface capsule involvement are poor prognostic factors. Adjuvant therapy did not confer an improved outcome; however, it was likely used in only those patients with poor prognostic indicators and so improved their survival to that of women with good prognostic factors who received surgery alone.     

Diagnosis and treatment of intrauterine adhesions

Twenty-four cases of intrauterine adhesions (Asherman's syndrome) were reported. The characteristic clinical picture was amenorrhea of hypomenorrhea accompanied by periodic lower abdominal pain. Intrauterine adhesions were demonstrated by hysterography in 14 cases. Lysis of adhesions was performed in 14 patients through vaginal route and in 3 by abdominal hysterotomy. Cyclic abdominal pain disappeared after treatment in all patients and normal menses were established in 16 cases (94%). In 11 patients with intrauterine adhesions developing after trauma, 3 conceived for 4 times all resulting in full term deliveries of healthy babies. The etiologic factors method of diagnosis and treatment of intra-uterine adhesions and prevention of readhesion are discussed.     

Pregnancy outcomes in young Turkish women

STUDY OBJECTIVE: We documented adolescent pregnancies that were thought to be at high risk for increased obstetric complications. DESIGN, SETTING, PARTICIPANTS: This study covered 442 pregnant women who were under 19 years of age and who delivered in Cukurova University, School of Medicine, Department of Obstetrics and Gynecology between January 1, 1993 and December 31, 1997, retrospectively. RESULTS: The patients' mean age was 18.24 years and their mean gestational age was 38.2 weeks. The newborns' mean birthweight was 3093.05 g and their mean birth height was 45.75 cm. Apgar score in the 1st minute was 6.79 and at the 5th minute 8.37. Cesarean section rate was 28.5%. The most common causes were pregnancy-induced hypertension (PIH) and breech delivery. There were 32 stillborns and 5 early neonatal deaths. The most frequent obstetric complications were PIH (14.5%), preterm delivery (7.0%), and low birthweight (< 2000 g) (10.2%). The pregnant adolescents with obstetric problems (44.4%) had poor obstetric results. CONCLUSIONS: Adolescent pregnancies are considered high risk with many obstetric complications and poor obstetric results. To decrease the complications adolescent pregnancies must be followed-up as high risk pregnancies, especially in developing countries where socioeconomic factors are more pronounced.     

Failure of peritoneal irrigation with heparin during pelvic operations upon young women to reduce adhesions

Prevention of intraperitoneal fibrin formation has attracted attention in attempting to limit development of peritoneal adhesions. Operations on the pelvis for infertility were performed upon 92 patients, in all of whom the exposed peritoneal serosa was irrigated throughout with warm isotonic Ringer's lactate solution. In 44 randomly assigned patients, heparin 5,000 International units per liter was added to the irrigating solution. Forty-eight patients received no heparin. Laparoscopy was carried out in all patients within 12 days of operation in order to diagnose and treat pelvic adhesions. Analysis of adhesion improvement scores in relation to initial adhesion scores showed that no significant benefit was obtained from the use of heparin. The probability that an important beneficial effect of heparin was missed in the study was slight (p less than 0.03, 1-tailed). It is concluded that the use of heparin to irrigate the peritoneal serosa during elective operations upon the pelvis has no important action in reducing the development of peritoneal adhesions.     

Factors affecting clinical outcomes in women with non-gastric gastrointestinal stromal tumors

ObjectiveThe clinical presentation of non-gastric GISTs might mimic adnexal cancer, and non-gastric GIST might be managed and treated by gynecologists. Knowledge of the clinical outcomes of women with non-gastric gastrointestinal stromal tumors (GISTs) is important. Our aim is to elucidate the factors affecting the clinical outcomes of women with non-gastric GISTs.Materials and methodsBetween January 2000 and October 2019, all consecutive women with non-gastric GISTs who underwent surgery in a tertiary referral center were reviewed.ResultsTwenty-six women were reviewed. Eight (31%) women experienced recurrence. The probabilities of recurrence-free survival (RFS) at 60 and 120 months were 65.2% and 55.9%, respectively. The probabilities of overall survival (OS) at 60 and 120 months were 71.1% and 63.9%, respectively. Cancer stage was the only independent predictor of RFS (hazard ratio = 6.00, p = 0.007) and OS (hazard ratio = 3.88, p = 0.04). However, excluding cancer stage, metastasis (hazard ratio = 8.74) was the only independent predictor of RFS, and tumor size (hazard ratio = 1.20) and metastasis (hazard ratio = 6.03) were independent predictors of OS. Tumor size ≥13.9 cm was the optimum cut-off value to predict death and had an area under the receiver operating characteristic curve of 0.75 (95% confidence interval = 0.53 to 0.98). Among the above 5 women with non-gastric GISTs admitted to the Gynecology Department, optimal debulking surgery was performed in two women, and small bowel resection was performed in three women; and all five women remained alive without disease.ConclusionNon-gastric GISTs may mimic gynecologic tumors. Metastasis was an independent predictor of PFS. In addition, metastasis and large tumor size (especially ≥13.9 cm) were independent predictors of OS in women with non-gastric GISTs.     

A clinicohysteroscopic scoring system of intrauterine adhesions

We propose a new scoring system for intrauterine adhesions (IUA) that may predict the prognosis after hysteroscopic adhesiolysis. We analyzed hysteroscopic findings and clinical data of patients diagnosed as having IUA by reviewing previously published hysteroscopic classifications of IUA. The data were subjected to evaluation according to the most popular classifications in addition to the proposed classification using a scoring system for different parameters. The results obtained by the proposed scoring system matched well with other classifications regarding grade I and III IUA. But in the cases with moderate IUA (grade II), there was overlap between the classifications (sensitivity 58.3%) which can be attributed to considering the menstrual and reproductive history. Further studies are needed to assess its prognostic value.     

Pregnancy outcome following treatment of intrauterine adhesions

Twenty-five patients were evaluated for reproductive failure and menstrual dysfunction before and after therapy of intrauterine adhesions. The patients were classified according to the extent of adhesion formation by means of a classification proposed by Toaff and Ballas. A pretherapy successful pregnancy rate of 32% was increased to 52% posttherapy. The spontaneous abortion rate of 78% was improved to 20% posttherapy. Altered menstrual function was noted in six of 25 patients. A correlation between the extent of intrauterine adhesion formation and pregnancy outcome following therapy could not be demonstrated. The authors recommend the adoption of a classification system based on hysteroscopic findings which may serve as a standard method of reporting to allow for comparison of treatment regimens and ultimately for prediction of pregnancy outcome.     

493例宫腔粘连患者的临床资料分析

目的:探讨宫腔粘连(IUA)患者粘连程度的高危影响因素。方法:回顾2012年1月至2014年6月北京大学第三医院生殖医学中心经宫腔镜确诊的493例IUA患者的临床资料,根据粘连程度分组,分析影响粘连程度的相关因素。结果:不同粘连程度IUA患者的平均年龄、月经周期和中孕妊娠丢失情况比较,差异均无统计学意义(P0.05);不同粘连程度IUA患者的月经量、原发不孕几率、结核病史和内膜炎情况均存在显著差异(P0.05);随着粘连程度的增加,经量减少、原发不孕及结核病史的患者所占的比例逐渐增加,而合并内膜炎患者的比例呈下降趋势。IUA粘连程度与妊娠相关的宫腔操作有关(P0.05),随着宫腔操作次数的增加,Ⅲ~Ⅴ度IUA患者明显增加。41.48%的IUA患者的子宫内膜超声结果正常,不同粘连程度患者的超声表现存在显著差异(P0.001),但随着粘连程度的加重,超声确诊粘连的比例无上升趋势。444例Ⅰ~Ⅲ度IUA患者中,内膜受损部位以中部居多,占45.05%;按粘连程度分组后,各组粘连部位存在统计学差异(P0.001),宫腔右侧粘连的比例明显高于左侧。结论:积极治疗感染性疾病,尽量减少宫腔创伤性操作,有助于避免IUA的发生;二维超声诊断IUA的敏感性低,宫腔镜检查是诊断IUA的金标准。