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991.
Objective To evaluate the rate and characteristics of postoperative intrauterine adhesions (IUA) that might be formed following hysteroscopic
reproductive surgery from both a gross and a histologic perspective as determined by early and late follow-up diagnostic hysteroscopy.
Methods Retrospective analysis of 61 women wishing a pregnancy and suffering from a significant intrauterine pathology affecting their
reproductive outcome were reviewed. All patients were treated hysteroscopically. Subsequently, they were randomly assigned
to perform a follow-up diagnostic hysteroscopy at a variable intervals from their initial surgery. Multiple hysteroscopic-guided
biopsies from IUA, when present, were obtained in several cases. Twenty patients were in the early group and had follow-up
hysteroscopy performed 2–4 weeks after the initial operation. The late diagnostic group consisted of 41 patients with follow-up
hysteroscopy at about 12 months (8–16 months). The two groups were similar to composition. Postoperatively, none of the early
diagnostic group underwent hysterosalpingography (HSG) whereas all of the late group performed HSG 4 months following the
initial surgery, which showed at least one-third of the cavity free of adhesions. When adhesions were present, no effort was
made to lyse them.
Results At follow-up hysteroscopy, 25% of both groups had no significant adhesions. Grade I adhesions (thin, filmy) occurred in 60%
of the early hysteroscopy patients and in only 12% of the late group (P < 0.05). Grade II adhesions were present in 10% of the early group and in up to 41% in the late group (P < 0.05), whereas Grade III adhesions were present in only 5% of the early hysteroscopy group, but in 22% of the late one
(P < 0.05). Correlation between hysteroscopic and histologic findings were good in most of cases in both groups. Follow-up to
determine the subsequent reproductive outcome revealed similar conception rates in both groups.
Conclusion The IUA that might be formed immediately following hysteroscopic reproductive surgery are histologically different from those
appearing a longer time after the original operation. Routine early follow-up hysteroscopy can influence the prognosis resulting
from the original surgery. 相似文献
992.
993.
994.
995.
de Tayrac R Chevalier N Chauveaud-Lambling A Gervaise A Fernandez H 《European journal of obstetrics, gynecology, and reproductive biology》2007,130(2):258-261
OBJECTIVE: The purpose of this study was to evaluate the prevalence of urinary symptoms at long-term follow-up after vaginal hysterectomy. STUDY DESIGN: One hundred and seventeen patients, who had a vaginal hysterectomy for menorrhagia, from January 1991 to December 2001, answered to a self-report questionnaire about de novo urinary symptoms. The control group was a population of 116 patients who had a conservative treatment for dysfunctional uterine bleeding by endometrial thermocoagulation from January 1994 to December 2001. RESULTS: Patient characteristics (mean age, mean parity, menopausal status, smoking status, drink habits) were similar in the two groups. Mean follow-up was 4.6+/-2.2 years (range 1.5-11) after vaginal hysterectomy and 4+/-1.8 years (range 1.5-7) after conservative treatment. The prevalence of urinary symptoms, included urge and stress incontinence, were statistically similar in the two groups. CONCLUSION: This study reveals no risk of urge or stress urinary incontinence at long-term follow-up after vaginal hysterectomy, compared with conservative treatment. 相似文献
996.
997.
Juretzka MM Abu-Rustum NR Sonoda Y Downey RJ Flores RM Park BJ Hensley ML Barakat RR Chi DS 《Gynecologic oncology》2007,104(3):670-674
OBJECTIVES: We previously reported our initial experience of patients with suspected advanced ovarian cancer and moderate to large pleural effusions who underwent video-assessed thoracic surgery (VATS) before planned abdominal exploration. The objective of this study was to report the surgical findings and management of patients who underwent VATS in an update of our experience. METHODS: We performed a retrospective review of all patients with suspected advanced ovarian cancer and moderate to large pleural effusions who underwent VATS for assessment of extent of intrathoracic disease at our institution between 6/01 and 8/05. RESULTS: Twenty-three patients with a median age of 61 years (range, 36-79) were identified. VATS was performed for right-sided effusions in 17 patients (74%), and a median of 1350 ml (400-3700 ml) of pleural fluid was drained. VATS demonstrated macroscopic disease in 15 (65%) patients, with nodules >1 cm in 11/15 (73%), and nodules <1 cm in 4/15 (27%). Macroscopic intrathoracic disease was found in 4/10 (40%) patients with negative cytology. Intrathoracic cytoreduction was performed in 3/11 patients (27%) with intrathoracic disease >1 cm. After VATS, 12/23 patients (52%) underwent primary surgical management, with cytoreduction to < or =1 cm achieved in 11/12 patients (92%). The other eleven patients received primary chemotherapy after undergoing diagnostic laparoscopy alone (4/11) or no further abdominal exploration (7/11). Nine of these patients proceeded to interval cytoreduction, while 2 had pathology demonstrating upper gastrointestinal and lymphoma primaries at the time of VATS. Final diagnosis of primary site of disease included: ovary, 14 (61%); endometrial, 2 (9%); dual ovarian/endometrial primaries, 1 (4%); fallopian tube, 1 (4%); primary peritoneal, 1 (4%); other, 4 (17%). Overall, findings at VATS altered primary surgical management in 11/23 (48%) patients. CONCLUSIONS: Sixty-five percent of patients with suspected advanced ovarian cancer and moderate to large pleural effusions had gross intrathoracic disease identified at VATS, with the majority (11/15, 73%) having disease >1 cm in diameter. Use of VATS allows for assessment of intrathoracic disease and may help identify candidates for primary cytoreductive surgery and possible intrathoracic cytoreduction versus neoadjuvant chemotherapy. 相似文献
998.
Levgur M 《Archives of gynecology and obstetrics》2007,276(1):1-15
Background To review the literature on various therapeutic modalities for uterine adenomyosis.
Methods Reviews, case-controlled studies and reports from November 1949 until August 2006 written in English or summarized in English
abstracts retrieved from Medline and Pubmed using the key words: adenomyosis and adenomyosis therapy.
Results Symptoms of adenomyosis may be alleviated by antiprostaglandins, sex hormones, danazol and GnRH analogs. Minor surgical procedures
for therapy include endomyometrial ablation, laparoscopic myometrial electrocoagulation and adenomyoma excision. Patient’s
age and symptoms, desired fertility, site and extent of lesion and surgeon’s skills should be considered in choosing the appropriate
procedure. Endomyometrial ablation is effective for lesions deeper than the endometrial–myometrial junction whereas the efficacy
of hysteroscopic ablation is limited to foci 2–3 mm deep. Focal and diffuse disease may be managed by laparoscopic electrocoagulation
or myometrial excision with preservation of fertility but risk of recurrence exists. Uterine artery embolization assumingly
invokes infarction and necrosis. Encouraging results reported in some cases warrant expanding its use for more experience.
Hysterectomy is the ultimate solution for women with deep myometrial involvement or if future fertility is not desired.
Conclusions Various therapeutic options for adenomyosis, including few minimally invasive procedures became available in the last two
decades but need evaluation and improvement. 相似文献
999.
Browning A Fentahun W Goh JT 《BJOG : an international journal of obstetrics and gynaecology》2007,114(11):1439-1441
Obstetric fistula is estimated to affect 2 million women worldwide and has considerable social and psychological effects on affected individuals. In this prospective study, 51 consecutive women with obstetric fistula admitted to the Barhirdar Hamlin Fistula Centre in the north of Ethiopia were screened using the General Health Questionnaire (GHQ-28) for potential mental health disorder before and 2 weeks after fistula surgery. Prior to surgery, all women screened positive. By 2 weeks after, this had dropped to 36% ( P = 0.005). 27% of the 45 women who were cured of their incontinence screened positive, while all 6 of those with severe residual incontinence continued to screen positive. We conclude that surgical treatment of obstetric fistula results in marked improvements in mental heath. 相似文献
1000.
Penketh R Griffiths A Chawathe S 《BJOG : an international journal of obstetrics and gynaecology》2007,114(4):430-436
OBJECTIVE: To assess the safety and acceptability of vaginal hysterectomy with and without simultaneous oophorectomy in a 24-hour day case surgery setting for women with nonprolapse indications for surgery. DESIGN: Prospective observational study. SETTING: A busy teaching hospital and tertiary referral centre for Obstetrics and Gynaecology. POPULATION: Seventy-one women from one consultant's practice underwent a vaginal hysterectomy with a planned discharge within 24 hours after the procedure. All women had a body mass index less than 40 and a suitable home environment for routine day case surgery, other than that the women were from an unselected population. METHOD: Prospective observational study. MAIN OUTCOME MEASURES: The duration of the operation and mean blood loss were recorded. Any intraoperative complications were noted. In addition, the proportion of women discharged home within 24 hours of the operation was recorded together with any readmissions to hospital. Returns to theatres and any postoperative complications were also recorded. Postoperative pain scores were assessed 6 and 24 hours after procedure in selected women. RESULTS: Seventy-one vaginal hysterectomies were performed as 24-hour day case procedures. The intraoperative complication rate was 1.4%. Sixty-five women were discharged home within 24 hours (91.5%). The readmission rate within this group was 6.2%. The duration of the procedure, mean blood loss, return to theatre rate and incidence of febrile illness were comparable with rates recorded in inpatient studies. CONCLUSIONS: Vaginal hysterectomy performed as a 24-hour day case procedure appears to be as safe as traditional inpatient management, with a high rate of early discharge and a low rate of readmission. This may have additional advantages for the woman and healthcare provider alike. 相似文献