425例妊娠合并卵巢肿瘤患者的诊治分析

目的:探究分析妊娠合并卵巢肿瘤的病理和诊治特点,以及不同手术方式对妊娠结局的影响。方法:以南方医科大学附属深圳市妇幼保健院2010年9月—2016年9月收治的425例妊娠期卵巢肿瘤患者为研究对象,回顾性分析其临床资料,包括发现时间、病理类型、手术方式以及妊娠结局等。结果:妊娠期卵巢肿瘤患者中,囊性成熟性畸胎瘤是最常见的病理类型,其次是子宫内膜异位囊肿及黏液性囊腺瘤;妊娠期有30例(7.10%)患者发生并发症,其中蒂扭转最常见,其次是恶变及破裂出血;妊娠期卵巢肿瘤手术主要有腹腔镜和开腹手术2种,腹腔镜组的失血量([39.62±28.25)mL vs.(68.50±33.60)mL,t=2.563,P=0.015]、住院时间([6.46±2.03)d vs.(9.90±1.92)d,t=4.925,P0.001]均小于开腹组。此外,腹腔镜组的平均手术孕周也小于开腹组([12.71±3.71)周vs.(16.71±4.89)周,t=2.490,P=0.018]。而2组之间的剖宫产率、低出生体质量儿发生率、早产率和流产率比较,差异均无统计学意义(均P0.05)。妊娠期恶性肿瘤在及时且个体化的处理后预后较好。结论:妊娠期卵巢肿瘤需首先排除恶性可能,早发现、早处理预后较好。妊娠期手术治疗是安全的,推荐有手术指征者选择手术干预。腹腔镜和开腹手术对妊娠结局影响均较小,可以个体化选择手术方式。     

高龄肥胖女性腹腔镜手术和开腹手术疗效比较

目的探讨高龄肥胖患者施行腹腔镜妇科手术的有效性与安全性。方法收集2009年1月至2017年6月在上海交通大学医学院附属瑞金医院妇科手术治疗的高龄(≥70岁)肥胖(BMI25.0)患者230例,其中行腹腔镜手术122例,开腹手术108例;记录患者美国麻醉师协会生理状况分级标准(ASA)分级、术前合并症、BMI、手术方式、术后诊断及并发症情况,并对手术结果进行统计分析。结果两组患者在年龄、BMI、ASA分级等方面差异无统计学意义,手术以全子宫切除术为多。合并心脏病和中重度肺通气功能障碍的患者多施行开腹手术。腹腔镜在全子宫切除中比开腹手术时间短[(57.26±7.68)min vs.(87.10±10.70)min,P0.05]、出血量少[(55.27±26.67)mL vs.(105.34±73.03)mL,P0.05]、排气时间短[(1.34±0.48)d vs.(2.29±0.75)d,P0.05]、住院时间短[(10.29±3.75)d vs.(14.18±5.44)d,P0.05]。在恶性肿瘤根治术中腹腔镜在手术时间[(167.69±19.64)min vs.(224.21±33.88)min,P0.05]和出血量[(193.07±117.50)mL vs.(351.58±261.71)mL,P0.05]的比较中比开腹手术有优势。尤其Ⅱ度肥胖比Ⅰ度肥胖者出血少的优势更明显。腹腔镜手术术后各类并发症少。良性卵巢巨大囊肿适合腹腔镜手术。结论腹腔镜手术能安全有效地治疗高龄肥胖女性的妇科良恶性疾病。     

妊娠与非妊娠女性卵巢肿瘤蒂扭转的临床特点及诊治比较

目的 探讨妊娠期与非妊娠期卵巢肿瘤蒂扭转患者的临床特征及诊治结局。方法 回顾性分析2009年1月至2018年12月在西安交通大学第一附属医院住院治疗,并经手术确诊为卵巢肿瘤蒂扭转的163例患者的临床、手术及病理资料,根据妊娠与否,分为妊娠组和非妊娠组进行分析。结果 （1）妊娠组下腹痛、伴恶心呕吐及腹膜刺激征发生率均低于非妊娠组,但差异无统计学意义（P均>0.05）。（2）妊娠组出现症状到住院的间隔时间长于非妊娠组,差异有统计学意义（P <0.05）。而妊娠组住院至手术的时间间隔显著短于非妊娠组（P <0.05）。（3）妊娠组卵巢囊肿平均直径小于非妊娠组,差异有统计学意义（P <0.05）。（4）非妊娠组患者术后病理类型最常见者为卵巢畸胎瘤34例（26.8%）;妊娠组最常见的为卵巢生理性囊肿10例（27.8%）。（5）妊娠组4例早期妊娠患者要求术中同时行人工流产术;1例妊娠23周的孕妇出现腹痛症状后1周就诊,术后4 h自然流产;26例随访至足月,妊娠结局良好;5例术后失访。结论 妊娠期卵巢肿瘤蒂扭转临床症状无特异,易延误诊治;妊娠期的附件手术未增加流产及母婴不良妊...     

妊娠合并妇科肿瘤的腹腔镜手术

文章着重对妊娠期宫颈肿瘤及妊娠期卵巢肿瘤的腹腔镜应用展开论述,与开腹手术相比,腹腔镜手术在胎儿妊娠结局上并没有差别,但腹腔镜手术具有腹部伤口小,手术时间短,手术过程中出血少,术后患者的恢复快等优势,使得腹腔镜在妊娠合并妇科肿瘤领域应用越来越广泛。     

286例妊娠合并卵巢肿瘤的临床分析

目的:探讨妊娠合并卵巢肿瘤的临床病程特点,以及相应的诊断和处理对母儿结局的影响。方法:回顾分析2003年3月至2010年12月在上海市第一妇婴保健院住院分娩的286例妊娠合并卵巢肿瘤患者的临床资料,分析比较诊断时孕周,妊娠期间卵巢肿瘤的特点、对妊娠结局影响、分娩方式,病理特点等,并对上述因素进行相关分析。结果:妊娠合并卵巢肿瘤的孕妇阴道分娩54例,剖宫产232例,剖宫产率81.12%;剖宫产获得的232例病理结果中,良性肿瘤227例,交界性肿瘤5例。良性肿瘤行卵巢肿瘤剥除术或患侧附件切除术,交界性肿瘤行患侧附件切除术或肿瘤减灭术;妊娠合并卵巢交界性肿瘤组新生儿体重及分娩孕周均明显低于妊娠合并卵巢良性肿瘤组(P<0.05)。结论:妊娠合并卵巢肿瘤以良性肿瘤最常见。因早期妊娠时缺乏典型的临床症状而不易早期诊断,故应加强孕前及早孕期间的检查;妊娠早期应行B超检查提高卵巢肿瘤检出率;剖宫产术中应仔细探查双侧附件,及时发现卵巢肿瘤;妊娠合并交界性肿瘤,由于终止妊娠时期早,故围产期母儿并发症较高,其处理原则需根据患者年龄、生育情况、组织类型、肿瘤期别、妊娠期限、胎儿成熟度评价等而异。     

妊娠合并卵巢肿瘤103例诊治分析

目的:探讨妊娠合并卵巢肿瘤的临床特点和诊断、处理方法。方法:对2005年1月至2010年12月我院收治的103例经手术及病理诊断的妊娠合并卵巢肿瘤患者的临床资料进行回顾性分析。结果:良性卵巢肿瘤99例(96.12%),非良性肿瘤中3例为交界性黏液性囊腺瘤,1例为黏液性囊腺癌。妊娠期卵巢良性肿瘤中以良性畸胎瘤为多见,有33例(32.04%)。孕早期超声诊断卵巢肿瘤42例;孕中期因常规检查超声诊断卵巢肿瘤15例,因急腹症经超声诊断的卵巢肿瘤9例;有37例患者因产科指征行剖宫产术时,术中探查发现卵巢肿瘤。9例急腹症行急诊手术,扭转7例,破裂2例;63例于剖宫产术中同时行卵巢肿瘤剥除术;另31例于顺产后,再行手术治疗。结论:超声检查在诊断及监测妊娠期卵巢肿瘤具有重要的指导意义,适时的手术并不影响妊娠结局。     

腹腔镜与开腹子宫肌瘤剔除术后肌瘤残留、复发及妊娠结局的比较

目的：比较子宫肌瘤患者腹腔镜与开腹子宫肌瘤剔除术的手术学特点、术后肌瘤残留、复发情况及妊娠结局。方法 回顾性分析2008年1月至12月在北京协和医院同期行腹腔镜或开腹子宫肌瘤剔除术461例患者的临床资料,腹腔镜313例、开腹148例,比较其一般情况、围手术期特点、术后残留、复发及妊娠结局。结果开腹患者剔除最大肌瘤直径(7.6±3.0) cm、剔除肌瘤数目(5.6±5.5)个、剔除肌瘤重量(308 ±364)g均高于腹腔镜患者[分别为(6.8±2.0) cm、(2.4±2.1)个、(140±109)g],分别比较,差异均有统计学意义(P＜0.01)。与腹腔镜患者相比,开腹患者的手术时间长[分别为(74 ±35)、(89±32) min]、术中失血量增多[分别为(149±252)、(239±251)ml]、围手术期血红蛋白含量降低程度增大[分别为(15±12)、(22±14) g/L]、术后住院时间增加[分别为(4.4±1.3)、(6.4±1.6)d],分别比较,差异均有统计学意义(P＜0.01)。然而,腹腔镜与开腹患者术后残留率（分别为2.6％、1.4％）、复发率（分别为11.1％、12.3％）、术后妊娠率(分别为49.2％、9/13)比较,差异均无统计学意义（P＞0.05）。肌瘤数目是影响复发的主要因素（OR=2.805,95％CI为1.192 ～6.601,P=0.0180）。所有术后妊娠患者均未发生妊娠中子宫破裂。结论腹腔镜与开腹子宫肌瘤剔除术是有生育要求或要求保留子宫患者的有效、安全的治疗方式。大部分的子宫肌瘤手术可以通过腹腔镜完成。腹腔镜子宫肌瘤剔除术的术后残留率高于开腹术式,但术后短期复发率相近。多发肌瘤是复发的主要危险因素;肌瘤数目≥4个者腹腔镜子宫肌瘤剔除术后复发率增加。腹腔镜与开腹子宫肌瘤剔除术后妊娠率相当。     

开腹和腹腔镜下子宫肌瘤切除术后患者妊娠结局临床分析

目的探讨不同手术方式子宫肌瘤切除术对妊娠结局的影响。方法回顾性分析2009年1月至2014年10月北京大学人民医院妇产科收治的有开腹或腹腔镜下子宫肌瘤切除史101例孕妇的临床资料。根据手术方式将其分为腹腔镜组(50例)和开腹组(51例)。比较两组孕妇子宫肌瘤切除术中肌瘤的位置、大小、数目、术后感染、妊娠距手术时间及妊娠后母儿结局。结果腹腔镜组和开腹组孕妇的年龄、手术中肌瘤大小、类型、部位和个数比较,差异均无统计学意义(P0.05)。腹腔镜组手术后妊娠时间[(2.7±1.2)年]与开腹组[(4.3±2.5)年]比较,差异有统计学意义(P0.05)。两组孕妇的分娩孕周、阴道分娩、产后出血量、早产、新生儿体质量2 500g比例比较,差异均无统计学意义(P0.05)。两组孕妇均无前置胎盘、胎盘早剥及胎盘植入发生。腹腔镜组发生1例子宫破裂。结论开腹或腹腔镜下子宫肌瘤切除术对有生育要求的子宫肌瘤患者均安全可行,可获得较满意的母儿结局。     

腹腔镜手术治疗妊娠期卵巢良性肿瘤有效性和安全性分析

目的 探讨腹腔镜手术治疗妊娠期卵巢良性肿瘤的有效性和安全性,分析术后妊娠结局及子代的远期预后。方法 回顾性分析2007-2010年在佛山市第一人民医院诊治的妊娠期卵巢良性囊肿患者17例的临床资料,分析患者的一般情况、围手术期特点、术后妊娠结局及婴幼儿期的随访结果。结果 患者年龄(24.3±3.9)岁(19~34岁);手术治疗卵巢囊肿的孕周为(12.9±3.3)周(6~18周);手术时间(114.0±42.3)min(60~210min),术后病理成熟性囊性畸胎瘤9例(其中3例为双侧病变),黏液性囊腺瘤4例,滤泡囊肿1例,卵巢冠囊肿1例,子宫内膜异位囊肿1例,另1例为卵巢黄体囊肿扭转复位。所有患者术后均无不适;无并发症发生;孕期均无流产,分娩孕周(38.2±1.1)周;胎出生体重为(3050±180)g(2800~3500 g);术后均随访至婴幼儿期(3岁内),用儿科盖泽尔量表进行筛查,并与同年龄段婴幼儿对照,二者比较差异无统计学意义。结论 腹腔镜治疗妊娠期卵巢良性肿瘤是安全、有效的,不影响母婴结局。     

妊娠合并卵巢肿瘤82例诊治体会

目的探讨妊娠合并卵巢肿瘤的临床特征及对妊娠结局的影响。方法对2003年1月至2005年12月上海市第一妇婴保健院收治的82例经手术及病理诊断的妊娠合并卵巢肿瘤患者的临床资料进行回顾性分析。结果妊娠期卵巢良性肿瘤80例,占97.56%,以生殖细胞肿瘤为多见,透明细胞癌1例,黏液性囊腺瘤交界型1例;孕早期超声诊断病例14例,占孕期发现的总例数的48.28%;有8例出现并发症并行急诊手术,扭转5例,破裂3例,有11例术前行血CA125检查,升高7例,其中1例为黏液性囊腺瘤交界型;足月分娩78例,占95.12%。结论超声检查在诊断及监测妊娠期卵巢肿瘤具有重要的指导意义,适时的手术干预并不影响妊娠结局,血清CA125检查在妊娠期卵巢良恶性肿瘤鉴别的意义有待进一步探讨研究。     

孕期非产科手术87例围手术期管理及妊娠结局分析

目的探讨孕妇在孕期行非产科手术时麻醉方式、手术因素及患者是否存在感染对母胎的影响。 方法回顾性分析广州医科大学附属第三医院2015年1月至2018年8月收治的87例因非产科疾病行手术治疗孕妇的临床资料,分析患者疾病分类、最终分娩孕周、分娩方式、早产及流产率等妊娠结局,比较不同孕期、不同手术方式、麻醉方式及感染并发症对妊娠结局的影响。 结果87例患者疾病分类：急性阑尾炎35例(40.2%),宫内妊娠合并宫外孕7例(8.1%),卵巢囊肿蒂扭转9例(10.3%),卵巢肿物21例(24.1%),泌尿系结石13例(14.9%),胆囊结石2例(2.3%);不同孕期接受非产科手术孕妇妊娠结局比较,差异无统计学意义(P>0.05);不同手术方式孕妇的分娩孕周、分娩方式、流产率、早产率等方面比较,差异无统计学意义(P>0.05);椎管内麻醉及全身麻醉在分娩方式、分娩孕周、早产及流产等方面比较,差异无统计学意义(P>0.05)。孕妇合并感染对妊娠结局有影响,孕妇合并感染情况对妊娠结局有影响,感染组分娩孕周低于对照组[(34.7±0.7)周与(38.5±0.2)周,Z＝5.088,P<0.05]。感染组剖宫产率、早产率和流产率均高于对照组[41.7% (10/24)与31.7% (20/63), χ²＝7.585;50% (12/24)与7.9% (5/63), χ²＝19.588;50.0% (12/24)与0, χ²＝29.659;P值均<0.05]。 结论孕期行非产科手术仍然可以获得较满意的妊娠结局,对于病情稳定的患者,不同孕期进行手术、不同麻醉方式和不同手术方式对妊娠结局影响没有差别,但对于合并感染的患者,病情本身的进展可能会影响妊娠结局。     

卵巢交界性肿瘤保留生育功能的手术途径选择

目的:研究卵巢交界性肿瘤行腹腔镜或开腹保留生育功能手术对短期预后及妊娠的影响。方法:收集天津市中心妇产科医院2009年1月—2015年7月卵巢交界性肿瘤行保留生育功能手术患者共74例,其中开腹组30例,腹腔镜组44例。比较2组患者复发及妊娠情况。结果:开腹组较腹腔镜组年轻(P=0.018)、开腹组肿瘤最大径线超过腹腔镜组(P=0.000),腹腔镜组中未分期手术患者较开腹组多(P=0.000)。术后总复发率为6.7%(5/74),2组复发率比较差异无统计学意义(P=0.980)。保留生育功能术后患者总妊娠率为33.8%(25/74),其中开腹组为30.0%(9/30),腹腔镜组为36.4%(16/44),2组间比较差异无统计学意义(P=0.570);腹腔镜组未分期手术妊娠患者比例高于开腹组(P=0.041),其中术后妊娠患者中无复发。结论:腹腔镜保留生育功能的未分期手术短期预后及术后妊娠情况满意,对卵巢交界性肿瘤患者选择性行腹腔镜保留生育功能的未分期手术是安全可行的。     

腹腔镜与开腹手术治疗妊娠期附件包块效果及妊娠结局的比较分析

目的 评价妊娠期腹腔镜附件手术的效果及安全性。方法2000年4月至2005年9月将北京协和医院妇科妊娠期腹腔镜附件手术17例（早孕期3倒，中孕期14例）列为研究组，同期同孕周范围开腹附件手术19例（早孕期2例，中孕期17例）列为对照组，比较两组附件手术期情况及妊娠结局。结果早孕期研究组3例术后孕期顺利，足月分娩。中孕期两组患者在术前情况、手术方式和术后病理等方面差异无显著性（P〉0．05）。两组平均手术时间、术后出现宫缩例数、剖宫产率和新生儿体重差异均无显著性（P〉0．05）；术中平均出血量、术后疼痛率、镇痛药用药率、平均应用抗生素时间及平均术后住院日差异有显著性意义（P〈0．05）。两组新生儿均无畸形和窒息。结论在正确掌握妊娠期腹腔镜附件手术指征的前提下，腹腔镜术式对比开腹术式不增加术中和术后并发症，并具有术中出血少，术后疼痛轻。用药少，住院时间短的优势。     

卵巢交界性肿瘤手术治疗的预后相关因素分析

目的:探讨卵巢交界性肿瘤(BOTs)患者手术治疗后影响复发率及妊娠结局的相关因素。方法:收集郑州大学第三附属医院2010年3月至2018年12月手术治疗的96例BOTs患者的病例资料及随访结果,行回顾性统计学分析。结果:单因素分析显示患者术前CA₁₉₉水平、手术途径、手术范围、肿瘤直径、国际妇产科联盟(FIGO)分期与BOTs手术治疗后复发有关((印)P(正)<0.05),但多因素Logistic回归分析结果显示以上因素均不是肿瘤复发的独立危险因素。保守性手术组的手术时间、术中失血量均低于根治性手术组((印)P(正)<0.05),且复发率高于根治性手术组(16.1%vs 0,(印)P(正)<0.05)。根治性手术组、单侧附件切除术组及肿瘤剥除术组3组术后复发率分别为0、12.5%、18.2%,差异有统计学意义((印)P(正)<0.05)。腹腔镜组患者的无瘤生存期(DFS)明显高于开腹组(63.7月vs 50.9月),复发率低于开腹组(4.6%vs 25.6%),差异有统计学意义((印)P(正)<0.05)。在保留生育功能患者中,15例...     

Surgical Management of Adnexal Masses in Pregnancy: A Systematic Review and Meta-analysis

ObjectiveThe incidence of adnexal masses in pregnancy is 1% to 6%. Although surgery is often indicated, there are no definitive management guidelines. We aimed to investigate the optimal approach to surgical management of adnexal masses in pregnancy on the basis of a meta-analysis of previous studies.Data SourcesWe performed a systematic review using MEDLINE, Embase, Cochrane Library, and Clinicaltrials.gov from inception to July 17, 2020.Methods of Study SelectionThere were no restrictions on study type, language, or publication date. Comparative and noncomparative retrospective studies that reviewed operative techniques used in surgery of adnexal masses in pregnancy were included. Meta-analyses were performed to assess outcomes. This study was registered in the International Prospective Register of Systematic Reviews (CRD42019129709).Tabulation, Integration, and ResultsComparative studies were identified for laparoscopy vs laparotomy and elective vs emergent surgery (11 and 4, respectively). Elective surgery is defined as a scheduled antepartum procedure. For laparoscopy vs laparotomy, the mean maternal ages and gestational ages at time of surgery were similar (27.8 years vs 27.7 years, p = .85; 16.2 weeks in laparoscopy vs 15.4 weeks in laparotomy, p = .59). Mass size was larger in those undergoing laparotomy (mean 8.8 cm vs 7.8 cm, p = .03). The most common pathologic condition was dermoid cyst (36%), and the risk of discovering a malignant tumor was 1%. Laparoscopy was not associated with a statistically increased risk of spontaneous abortion (SAB) or preterm delivery (PTD) (odds ratio [OR] 1.53; 95% confidence interval [CI], 0.67–3.52; p = .31 and OR 0.95; 95% CI, 0.47–1.89; p = .88, respectively). The mean length of hospital stay was 2.5 days after laparoscopy vs 5.3 days after laparotomy (p <.001). The decrease in estimated blood loss in laparoscopy was not statistically significant (94.0 mL in laparotomy vs 54.0 mL in laparoscopy, p = .06). Operative times were similar in laparoscopy and laparotomy (80.0 minutes vs 72.5 minutes, p = .09). Elective surgery was associated with a decreased risk of PTD (OR 0.13; 95% CI, 0.04–0.48; p = .05). Noncomparative studies were identified for laparoscopy and laparotomy. Laparotomy had more SABs and PTDs than laparoscopy (pooled proportion = 0.02 vs 0.07 and pooled proportion = 0.02 vs 0.14, respectively).ConclusionLaparoscopy for the surgical management of adnexal masses in pregnancy is associated with shorter length of hospital stay and similar risk of SAB or PTD. Elective surgery is associated with a decreased risk of PTD.     

Surgery of borderline tumors of the ovary: retrospective comparison of short-term outcome after laparoscopy or laparotomy

BACKGROUND: Laparoscopic management of borderline ovarian tumors is controversial. OBJECTIVE: To retrospectively compare outcome after surgery by laparoscopy or laparotomy for borderline tumors. METHODS: Ovarian tumors from all women operated at Ullev?l University Hospital during a five-year period were re-evaluated histologically. Patients with borderline FIGO (International Federation of Gynaecology and Obstetrics) stage I tumors were retrospectively compared regarding surgery outcome following laparoscopy or laparotomy. RESULTS: Histological re-evaluation revealed only 3 misclassifications in 608 patients. Borderline tumors represented 36% of epithelial ovarian malignancies. The 107 borderline stage I included 52 serous, 53 mucinous, and 2 endometrioid tumors. Thirty-eight patients were operated on primarily by laparoscopy and 69 by laparotomy (including 14 women starting with laparoscopy). In the laparoscopy group, more women were premenopausal (63% versus 35%, p=0.01) and median tumor diameter was smaller (8.6 versus 16.4 cm, p<0.001) as compared to the laparotomy group. When tumor diameter exceeded 10 cm, intraoperative tumor rupture was significantly more frequent during laparoscopy than during laparotomy (p=0.01). Less postoperative complications were seen after laparoscopic operations (p=0.034), but laparoscopic surgeries were less extensive, without hysterectomy, as compared to laparotomy. During the 14-78 months follow-up time, no relapse occurred in either group. After fertility-sparing surgery, there was no statistical significant difference regarding successful pregnancies between the two groups. CONCLUSIONS: Laparoscopic treatment of borderline ovarian tumors is feasible if tumor is of moderate size (diameter below 10 cm), gives fewer complications, and shorter hospital stay. Long-term follow-up of larger materials is needed to determine the ultimate recurrence risk as well as fertility rates.     

Impact of surgical approach on the management of macroscopic early ovarian borderline tumors

OBJECTIVE: The aim of this study was to evaluate the impact of the surgical approach on the management and outcomes of patients with early borderline ovarian tumors (BOTs). MATERIAL AND METHODS: We retrospectively reviewed the medical charts of patients with stage Ia to Ic BOT treated surgically between January 1, 1985, and December 31, 2001. We compared patients initially managed by laparoscopy vs. laparotomy in terms of potentially harmful procedures and quality of staging. RESULTS: Of the 118 included patients, 48 (41%) had laparoscopy for initial surgery, 54 (45%) had laparotomy, and 16 (14%) had conversion from laparoscopy to laparotomy. Conservative treatment (57% of patients) was more common with laparoscopy (vs. laparotomy, P < 0.05) and in women older than 44 years (vs. younger than 44 years, P < 0.001). Intraoperative tumor rupture occurred in 9% of patients and was not associated with the surgical approach (P = 0.1). Bag extraction was used in 19 (40%) of the 48 laparoscopy patients. Staging was incomplete in 73% of patients overall. By univariate analysis, better quality of staging was associated with bilateral adnexectomy, age >44 years, laparotomy, hysterectomy, and treatment after 1995. By multivariate analysis, bilateral adnexectomy or hysterectomy was associated with better staging. Mean follow-up was 40 months, during which recurrence and survival rates were similar in the laparoscopy and laparotomy groups. CONCLUSION: Staging of macroscopic early stage BOTs was better in patients requiring radical surgery. After adjustment on disease severity, type of surgical access was not related to staging quality.     

Outcome of in vitro fertilization and ovarian response after endometrioma stripping at laparoscopy and laparotomy

OBJECTIVE: To add further data on in vitro fertilization (IVF) outcome and ovarian response after endometrioma stripping via either laparoscopy or laparotomy. STUDY DESIGN: IVF outcome and ovarian response parameters in patients who had undergone unilateral endometrioma stripping at laparoscopy (n=28) or laparotomy (n=10) before IVF were retrospectively compared. RESULTS: Fertilization rates, number of embryos transferred and pregnancy rates did not differ between the groups. Significantly more recombinant FSH was used to induce folliculogenesis, and fewer metaphase II oocytes were retrieved in the laparotomy group. The laparotomy-postcystectomy ovaries were significantly smaller and malpositioned. In both stripping groups, significantly smaller operated-on ovaries with lower numbers of antral and mature follicles were observed as compared to intact ovaries. CONCLUSION: A higher amount of FSH is needed to achieve an acceptable IVF outcome after unilateral endometrioma surgery. Indications for surgical treatment of patients having larger and bilateral cysts with an expectation for future fertility should be cautiously reviewed     

Laparoscopy compared with laparotomy for the surgical staging of endometrial carcinoma

AIM: To evaluate and compare laparoscopic-assisted surgical staging with conventional laparotomy for the treatment of endometrial carcinoma. METHODS: From July 2001 to December 2003, a retrospective review of patients with endometrial carcinoma was carried out. The medical records of those patients who had undergone surgical staging with hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy (PLN) were evaluated. Primary outcome measures were operating time (OT), estimated blood loss, total number of lymph nodes yielded, intraoperative complications, postoperative complications, and length of hospital stay. RESULT: A total of 64 cases were identified. Two cases were excluded because of incomplete records. Two cases with para-aortic lymphadenectomy and four cases with Wertheim's hysterectomy were excluded from the study. Thirty-six patients underwent laparotomy with total abdominal hysterectomy and bilateral salpingo-oophorectomy and PLN (laparotomy group). Twenty patients underwent the same surgery by laparoscopy, of which 19 were successfully carried out (laparoscopy group). One case was converted to laparotomy. The mean OT in the laparoscopy group was longer when compared with the laparotomy group (211 min vs 94 min, P < 0.001). The mean estimated blood loss in the laparoscopy group was less (200 mL vs 513 mL, P < 0.001). The post-operative hospital stay was shorter in the laparoscopy group (3.6 days vs 7.7 days, P < 0.001). The mean number of lymph nodes yielded was more in the laparoscopy group (26.1 vs 16.7, P = 0.004). Neither group had intraoperative complications and both had similar postoperative complication rates. CONCLUSION: Laparoscopic-assisted surgical staging for endometrial carcinoma is associated with significantly less blood loss, shorter hospital stay, longer OT time, and more lymph nodes yielded when compared with laparotomy.