Primary tubal choriocarcinoma

Choriocarcinoma is one of the most serious forms of gestational trophoblastic tumor. It is a malignant tumor from the epithelium of the chorionic villi. The most frequent location site is the uterus. Associated with ectopic pregnancy, it is extremely rare and in general, very aggressive. In 75% of the cases, it items from distant metastasis; therefore, a histological examination of the tubes must be performed in all ectopic pregnancies. Our patient was a 33-year-old woman who was admitted to emergency room (ER) with an intense pain in the right, iliac cavity, and limited genital bleeding. During the exploration, there was abdominal pain, with doubtful signs of peritoneal irritation. The vaginal ultrasound offered an image that was compatible with an extra uterine pregnancy in the left appendages. At emergency, right salpingectomy was performed via laparotomy. The patient was treated with polychemotherapy and contraceptives for a year, with no recurrence of the disease. Control follow-up was performed using beta-human chorionic gonadotropin (HCG) testing on a weekly basis during the first month and then bi-monthly during the first year of follow-up.     

Bilateral salpingectomy does not compromise ovarian stimulation in an in-vitro fertilization/embryo transfer programme

The question whether salpingectomy has a negative influenceon ovarian function and the outcome of pregnancy in an in-vitrofertilization (IVF) and embryo transfer treatment programmeis not yet answered. We performed a retrospective case-controlstudy to investigate the possible negative effect of salpingectomyon ovarian response to human menopausal gonadotrophins (HMG)during IVF and embryo transfer. The study group was composedof 26 patients with bilateral salpingectomy. In 67 cycles weanalysed different parameters of ovulation such as the numberof days of ovarian stimulation, numbers of ampoules of HMG,pre-ovulatory oestradiol concentrations and the numbers of oocytesretrieved. These parameters were compared to a control groupof 134 cycles in 134 women with healthy Fallopian tubes. Nodifferences were found. Implantation ratio, pregnancy rate andoutcome were the same in both groups. We conclude that bilateralsalpingectomy had no detrimental effect on ovarian performanceduring IVF and embryo transfer treatment nor on the outcome.     

Removal of hydrosalpinges increases endometrial leukaemia inhibitory factor (LIF) expression at the time of the implantation window

BACKGROUND: The presence of hydrosalpinges is associated with lower implantation and pregnancy rates in women undergoing IVF-embryo transfer, while salpingectomy improves these parameters. Although the mechanism by which hydrosalpinges affects fertility is not entirely understood, an adverse effect on endometrial receptivity has been postulated. In this study, we hypothesized that the adverse effects of hydrosalpinges on fertility may be in part mediated by inappropriate endometrial expression of leukaemia inhibitory factor (LIF), a cytokine implicated in implantation. METHODS: In order to test our hypothesis, we prospectively examined the expression of LIF during the window of implantation in the endometrium of infertile women (n = 10) with hydrosalpinges prior to and following salpingectomy and of fertile controls (n = 10) by Western blotting and immunohistochemistry. RESULTS: LIF expression was significantly lower in infertile women with hydrosalpinges compared with fertile controls (P < 0.05). Salpingectomy resulted in an increase in LIF expression in eight out of 10 women with hydrosalpinges. LIF levels were increased by 231 +/-49% (mean +/- SEM) following salpingectomy. Immunohistochemical analysis confirmed the Western blot findings. The increased LIF immunoreactivity was predominantly localized to luminal and glandular epithelial cells. CONCLUSIONS: Our findings suggest that observed benefit from salpingectomy in infertile women with hydrosalpinges may be in part mediated by the up-regulation of endometrial LIF expression.     

Pregnancy: Determinants of reproductive prognosis after ectopic pregnancy

The reproductive prognosis of 115 women desiring pregnancy whounderwent surgery for ectopic pregnancy between 1985 and 1990at the Clinica Luigi Mangiagalli, was analysed after a medianfollow-up period of 26 months (range 2–83). Probabilityof reproductive events was assessed by a product-limit model.Women who underwent surgery for ectopic pregnancy had a 54%probability of becoming pregnant (cumulative pregnancy rate,CPR) and a 36% probability of giving birth to a child (cumulativelivebirth rate, CLB) during the 3 years after surgery. Thesepercentages dropped with history of previous ectopic pregnancy(respectively 33%, P = 0.07, and 7%, P < 0.05). Increasingage at surgery and presence of adhesions in the contra-lateraltube seemed to be associated with poor reproductive prognosis(CPR = 40% and CLB = 12% for women aged 35 years and CPR = 37%and CLB = 20% in women with adhesions in the contra-lateraltube), but these findings were not statistically significant.No association emerged between fertility and parity or typeof surgery. The recurrence rate of ectopic pregnancy was 20%.No significant association emerged between recurrence of ectopicpregnancy and age, history of previous pregnancy, history ofprevious ectopic pregnancy, non-intact contra-lateral tube andsalpingotomy.     

输卵管切除术对超排卵的影响

目的:探讨单侧输卵管切除,切除侧卵巢对超排卵的反应性。方法:以因输卵管妊娠行单侧输卵管切除后不孕接受IVF-ET治疗的患者45例共52个周期为研究组,并以同期因输卵管阻塞(无输卵管积水)不孕行IVF-ET治疗的患者875例共913个周期为对照,分析输卵管切除侧卵巢与对侧卵巢对超排卵的反应性。结果:①两组的促性腺激素(Gn)用量、用药天数、hCG日E_2水平、卵裂率、平均移植胚胎数、种植率、临床妊娠率、流产率、异位妊娠率差异无统计学意义(P>0.05)。但单侧输卵管切除组的获卵数减少,差异有统计学意义(P<0.05)。②研究组卵泡晚期(注射hCG日)两侧卵巢大小(分别为35.1±6.5mm、38.2±5.9 mm)有差异,P<0.05。取卵日两组卵泡数(个)分别为6.7±4.5、8.6±3.3(P<0.05),回收卵子数(个)分别为4.9±3.7、6.4±3.6,P<0.05。结论:单侧输卵管切除者切除侧卵巢在行超排卵时,其卵泡晚期(注射hCG日)卵巢较小,取卵日的卵泡数和回收卵子数明显减少,手术可能影响卵巢的血液供应和超排卵效果。     

Tubal pregnancy after clomiphene treatment: are you sure is not bilateral?

The estimated prevalence of ectopic pregnancy (EP) is 1–2% worldwide. Bilateral tubal pregnancies represent the rarest form of heterotopic pregnancy, and spontaneously conceived are extremely unusual, as many cases are derived from assisted reproductive techniques. We describe a case of bilateral tubal pregnancy after clomiphene therapy and sexual intercourse in which the second EP was not contemporarily revealed.     

腹腔镜与开腹全子宫加双侧输卵管切除术的疗效和对患者术后性生活质量影响的比较

目的 探讨腹腔镜与开腹全子宫加双侧输卵管切除术对子宫疾患患者的疗效和术后性生活质量的影响。方法 选择2018年1月至2019年9月在铜陵市人民医院接受全子宫加双侧输卵管切除手术治疗的115例子宫疾患患者,根据手术方式不同将患者分为腹腔镜组（n=43）和开腹组（n=72）,腹腔镜组采用腹腔镜下全子宫加双侧输卵管切除术治疗,开腹组采用传统的经腹式全子宫加双侧输卵管切除术治疗。比较两组患者手术时间、术中出血量、术后住院时间、术后通气时间、住院总费用以及阴道残端并发症与术后性生活质量等情况。结果 腹腔镜组患者术后通气时间及术后住院时间短于开腹组,术中出血量明显少于开腹组,差异均有统计学意义（P<0.05）;腹腔镜组患者手术时间长于开腹组,住院总费用高于开腹组,差异均有统计学意义（P<0.05）;腹腔镜组术后阴道残端肉芽增生发生率为7.9%,低于开腹组的29.7%,且术后性交痛和性交不适较开腹组也明显减少,差异均有统计学意义（P<0.05）。结论 腹腔镜全子宫加双侧输卵管切除术较传统开腹全子宫加双侧输卵管切除临床效果更好,患者术后性生活质量更满意,值得临床推广。     

心理支持对宫外孕患者术后焦虑及其相关因素的影响

目的探讨心理支持对宫外孕患者输卵管切除术后身心康复的作用。方法采用Zung焦虑自评量表和自制的情绪问卷调查表,对我院2003年6月至2004年6月收治的92例宫外孕患者于术后第1天进行问卷调查,针对焦虑和情绪相关因素给予个性化心理支持,并在术后第5天用相同问卷复查,比较心理支持前后焦虑及情绪相关因素的差异。结果心理支持前后患者的焦虑均值与情绪相关因素均值差异均有统计学意义(P<0.01)。结论心理支持可减轻宫外孕患者输卵管切除术后的焦虑和不良情绪,促进其身心康复,提高生活质量。     

预防性输卵管切除的循证医学证据

临床资料已经证实输卵管是高级别浆液性卵巢癌的发源地，对绝经前妇女行预防性输卵管切除可降低卵巢癌的发生，并已作为卵巢癌的一级预防。近年来，人们日益关注输卵管预防性切除术在卵巢癌预防中的价值。文章将从循证医学的角度，探讨预防性输卵管切除对降低卵巢癌发生的价值，以及输卵管切除术对卵巢功能的影响。     

Ovarian response to gonadotropin stimulation in repeated IVF cycles after unilateral salpingectomy

Purpose : This study aimed to examine ovarian response to gonadotrpoin stimulation after repeated IVF treatment cycles in patients who underwent previous unilateral salpingectomy for tubal pregnancy. Methods : The study group included 26 patients who underwent unilateral salpingectomy for tubal pregnancy 1–9 years prior to starting IVF treatment. A control group of 52 patients with anatomically intact pelvis was treated during the same time period by ICSI. The two groups were matched for age, number of gonadotropin ampules, and length of stimulation. End point measurements included number of follicles, oocytes, and cleaved embryos in consecutive treatment cycles of each group. Results : There were 98 cycles in the study group and 154 cycles in the control group. The mean number of follicles, retrieved oocytes, and cleaved embryos were not different in the two groups, and no reductions in these parameters were noted up to 10 cycles of treatment. The mean number of follicles ipsilateral to the operated side was similar to the number of follicles of the contralateral ovary and was not different whether salpingectomy was by laparoscopy or laparotomy. Conclusions : Unilateral salpingectomy does not affect ipsilateral ovarian response to gonadotropin stimulation even after repeated IVF treatment cycles.