Objective To systematically review the effectiveness and safety of different laparoscopic surgeries for ovarian endometrioma (OE). Methods Such databases as The Cochrane Library (Issue 3, 2011), MEDLINE (1966 to November 2011), EMbase (1980 to November 2011), CNKI (1980 to November 2011), CBM (1980 to November 2011) and WanFang Data (1978 to November 2011) were searched on computer, and the relevant references of the included literature were also retrieved manually to collect the randomized controlled trials (RCTs) about laparoscopic cystectomy vs. laparoscopic coagulation for OE. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data and assessed quality. Then RevMan 5.1 software was used for meta-analysis. Results A total of 5 RCTs were included. The results of meta-analysis showed that, laparoscopic cystectomy for OE could reduce the reocurrence rates of dysmenorrhoea (RR=0.29, 95%CI 0.15 to 0.55, P=0.000 2), dyspareunia (RR=0.27, 95% CI 0.09 to 0.77, P=0.01) and non-menstrual pelvic pain (RR=0.19, 95% CI 0.05 to 0.76, P=0.02), decrease 1-year (RR=0.33, 95%CI 0.15 to 0.74, P=0.007) and 2-year (RR=0.49, 95%CI 0.26 to 0.95, P=0.03) postoperative reoccurence of OE, and lower the risk of short-term secondary operation (RR=0.25, 95%CI 0.07 to 0.85, P=0.03). However, it didn’t increase the 12-month (RR=2.82, 95%CI 1.44 to 5.50, P=0.002) and 24-month (RR=2.62, 95%CI 1.47 to 4.68, P=0.001) postoperative spontaneous pregnancy rates (SPR). In addition, although laparoscopic coagulation was superior to laparoscopic cystectomy in the 6-month postoperative ovarian reserve function (ORF), there was no significant difference in the 5-year postoperative ORF between the two groups (WMD=0.27, 95%CI −0.18 to 0.73, P=0.24). Conclusion Laparoscopic cystectomy for OE can reduce the reoccurence of dysmenorrhoea, dyspareunia, non-menstrual pelvic pain and endometriosis, decrease the risk of short-term secondary operation, and increase the postoperative SPR in women who had been diagnosed as infertility. Because of the quantity limitation of present clinical trials, this conclusion requires to be further proved by performing more high quality RCTs.
Objective To explore the application value of self-made visual teaching aids in gynecological and obstetrical nursing education. Methods A total of 240 nursing students in grade 2009 from Fujian Medical University and Fujian Health College were selected by cluster sampling and divided by simple randomization into 2 groups (the trial group and the control group). Besides the multimedia combined with traditional teaching adopted in both groups, the visual teaching aids for fetal intrauterine condition was also adopted in the trial group rather than the control group. Questionnaire survey and focus group interview were adopted to appraise the satisfactory degree of all nursing students and the teaching effects evaluation of students in the trial group. Results There were no significant differences between the two groups in education background, and intelligibility evaluation of theoretical study on both the fetal intrauterine condition and the complications in pregnancy and delivery periods (Pgt;0.05), while the difference was statistically significant in the satisfactory degree between different teaching methods (Plt;0.05). 85.0% of nursing students in the trial group thought that visual model could help them to better understand the complications in pregnancy and delivery periods, and the intrauterine condition, 99.17% of students thought that the teaching effect of visual model was better than traditional teaching, and 95.83% of students considered that visual model was favorable for course study. Conclusion The application of self-made visual teaching aids for fetal intrauterine condition makes gynecological and obstetrical nursing education more visual, facilitates students to better understand fetal intrauterine situation and part of the mechanism of pregnancy complications, arouses students’ learning interests, and lays a theory and practice foundation for follow-up internship, so as to enhance the quality of nursing teaching.
Objective To assess the clinical effectiveness and safety of laparoscopy versus laparotomy for endometrial cancer. Methods The databases such as The Cochrane Library, PubMed, EMbase, Ovid, CNKI, WanFang Data, and VIP were searched to collect the randomized control trials (RCTs) about the clinical effectiveness and safety of laparoscopy and laparotomy for endometrial cancer. The retrieval time was from January 1998 to September 2012. Two reviewers independently screened the literature according to the inclusive and exclusive criteria, extracted the data, and assessed the methodological quality of included studies. Then the meta-analysis was performed by using RevMan 5.0 software. Results A total of 10 RCTs involving 6 993 patients were included. Meta-analysis showed that, compared with laparotomy, laparoscopy had lesser amount of intraoperative bleeding, lower decrease of hemoglobin before and 1-day after operation, shorter time of both waiting for postoperative gas and hospital stay, lower incidence of postoperative complications, longer operation time, and higher incidence of intraoperative complications. Additionally, there were no differences between the 2 groups in the number of pelvic and para-aortic lymph nodes removed during operation, as well as the postoperative recurrence and mortality rates in 3-5 year follow-up. Conclusion Compared with laparotomy, laparoscopy shows lesser amount of intraoperative bleeding, lower decrease of hemoglobin before and 1-day after operation, shorter time of both waiting for postoperative gas and hospital stay, lower incidence of postoperative complications. But laparotomy shows lower incidences of intraoperative complications, and shorter operation time. Both operations are similar in the number of pelvic and para-aortic lymph nodes removed during operation, as well as the postoperative recurrence and mortality rates in 3-5 year follow-up. For quantity limitation and low methodological quality of included studies, this conclusion still needs to be further proved by performing more high-quality and large scale RCTs.
Objective To systematically evaluate the correlation between endometriosis (EM) in Chinese women and Xba I polymorphism in intron-1 of estrogen receptor α (ER-α) gene. Methods Such databases as PubMed, MEDLINE, The Cochrane Library (Issue 3, 2012), VIP, CBM, WanFang Data and CNKI were searched to collect case-control studies about the correlation between EM and Xba I polymorphism in intron-1 of ER-α gene. The retrieval time was from 1980 to 2012. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data and assessed the quality, and then the meta-analysis was conducted by using RevMan 5.0 and Stata 12.0 software. Results A total of 7 studies involving 676 EM patients and 688 healthy volunteers were included. The results of meta-analyses showed that Chinese women with X/X genotype had similar risk of EM compared to those with x/x genotype (OR=0.95, 95%CI 0.58 to 1.54, P=0.82) or X/x genotype (OR=0.73, 95%CI 0.44 to 1.20, P=0.22). The allele X also showed similar risk of EM compared to the allele x (OR=1.11, 95%CI 0.93 to 1.33, P=0.25). Conclusion At present, it has not yet been found that the incidence of EM in Chinese women is related to the Xba I polymorphism in intron-1 of ER-α gene as well as the allele X. For the quantity and quality limitation of the included studies, this conclusion has to be proved by more studies.
Objective To systematically evaluate the correlation between coffee and risk of endometrial cancer. Methods Such databases as CBM, CNKI, WanFang data, PubMed, EMbase and The Cochrane Library (Issue 5, 2012) were searched to collect the prospective cohort studies about correlation between coffee and endometrial cancer. The retrieval time was by the end of May 2012, and the references of the included literature were also retrieved. Two evaluators independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the quality, and then the statistical analysis was conducted by using Stata 12.0 software. Results A total of 10 cohort studies involving 4 484 patients with endometrial cancer were included. The results of meta-analysis showed that, compared with the women who didn’t drink coffee or drank in the lowest dose, the women who drank coffee in the highest dose had a decreased risk of endometrial cancer (RR=0.69, 95%CI 0.62 to 0.78), same as the women who drank coffee frequently (RR=0.83, 95%CI 0.77 to 0.89). The results of dose-response analysis revealed that, when there was an increase of 2 more cups of coffee per day, there was the risk of endometrial cancer decreased by 12%. Conclusion Drinking coffee frequently (more than 2 cups per day) can decrease the risk of endometrial cancer which can be significantly decreased when drinking in a big dose (more than 5 cups per day).
Objective To systematically assess the correlation between smoking and the risk of endometriosis, so as to offer scientific basis to health education and preventing decision. Methods A literature search was performed in The Cochrane Library, Pubmed, Embase, CBM, CNKI and Wanfang database to collect the case control studies on the correlation between smoking and endometriosis. Two reviewers independently screened the literatures according to the inclusion and exclusion criteria, extracted the data, assessed the quality, and then conducted Meta-analyses on the 13 included RCTs by using RevMan 5.0 software, with calculation of the OR value and 95%CI. Results A total of 13 case control studies involving 14260 cases were included, of which 1900 ones were endometriosis. The quality assessment indicated that 2 studies were in quality of Level A, 4 were Level B, 7 were Level C, totally meant low quality. Meta-analyses showed that compared with non-smokers, there was no increasing possibility of endometriosis in smokers (OR= 0.91, 95%CI 0.82 to 1.02). The geographical subgroup analyses showed there was no significant difference in the incidence of endometriosis between the non-smokers and smokers in North America (OR=0.96, 95%CI 0.84 to 1.08), but a significant difference was found between non-smokers and smokers in Europe (OR=0.72, 95%CI 0.54 to 0.97). Conclusion There is no causative relationship between smoking and incidence of endometriosis. However, more high-quality trials are expected for further study because of the heterogeneity and poor quality of the current included studies.
Objective To evaluate the effectiveness of TCu380AIUD comparing with other common IUDs. Methods CBMDISC (1979 to 2005), Wanfang (1994 to 2005), CNKI (1974 to 2005), CMCC (1979 to 2005), CMAC (1994 to 2005), EMbase (1974 to 2004), MEDLINE (1974 to 2005), WHO/RHL (2004 to 2005), The Cochrane Library (Issue 4, 2004), SCI (1985 to 2005), POPLINE (1966 to 2003) and 9 relevant journals were searched for randomized controlled trials (RCTs) comparing TCu380AIUD with other common IUDs. The quality of included trials was critically appraised. RevMan4.2.7 software was used for statistical analysis. Results Fifteen published studies involving 20 417 participants were included. The results of meta-analyses were expressed with OR (cumulative expulsion rate, cumulative pregnancy rate, cumulative rate of removing for medical reasons) and 95% CI. Compared with TCu380A, TCu220C resulted in lower cumulative expulsion rate at 0.5 and 1 year of follow-up [OR 0.36 (0.18 to 0.70); 0.44 (0.31 to 0.62), respectively], higher cumulative pregnancy rate at ten years of follow-up [1.22 (1.04 to 1.43)], lower cumulative rate of removing for medical reasons at 0.5 year of follow-up [0.59 (0.36 to 0.97)]; MLCu375 resulted in higher cumulative expulsion rate at 1 year of follow-up [2.17 (1.29 to 3.67)], higher cumulative pregnancy rate at 1 and 2 years of follow-up [1.72 (1.18 to 2.50); 1.28 (1.02 to 1.60)]; UCD300 resulted in lower cumulative expulsion rate at five years of follow-up [0.38 (0.27 to 0.56)]; Medicated Gamma 380IUD resulted in lower cumulative rate of removing for medical reasons at 1 year of follow-up [0.31 (0.14 to 0.70)]. Conclusions Compared with TCu380A which is considered as a standard of IUDs, the performance of TCu220C is inferior in contraception, but TCu220C is also a good IUD in performance; The overall clinical performance of MLCu375IUD was as good as that of TCu380A; UCD300 is of the characteristic of lower cumulative expulsion rate; Medicated Gamma 380IUD can decrease side effects effectively. However, larger multi-center randomized comparative trials with longer follow-up periods are needed to confirm the conclusion
Objective To evaluate the effectiveness of Medicated γ-IUD compared with other IUDs for contraception. Methods CBMdisc （1986 -2005）, VIP （1989 -2005） , CNKI （1994-2005） , The Cochrane Library （Issue 4, 2005 ） and 10 related journals were searched for randomized controlled trials （R.CTs） and quasi-randomized controlled trials （quasi-RCTs） on the comparison between γ-IUD and other IUDs. The quality of included trials was critically appraised. RevMan 4.2.8 software was used for statistical analysis. Results Ten published studies with 8 381 participants were included. The results of meta-analysis were expressed with Peto OR （ cumulative pregnancy rate, cumulative expulsion rate, cumulative rate of removing for medical reasons） or OIL （ cumulative continuation rate ） and 95% CI. Compared with MSSR-165, Medicated γ-25,200 resulted in lower pregnancy rate at 1, 2, 3 years of follow-up [ with the OR （95% CI） 0. 31 （0.15,0.64） , 0. 31 （0. 17,0.54） , 0. 31 （0.19,0. 51） , respectively], lower cumulative expulsion rate in5 year follow-up [0.26 （0.17,0.40）, 0.28 （0.20,0.41）, 0.30 （0.21,0.42）, 0.29 （0.19,0.44）, 0.32 （0.21, 0. 48 ）, respectively], lower cumulative rate of removing for medical reasons.after 4 year follow-up [0.57 （0.36,0. 92 ） ], and higher rate of cunmlative continuation in 5 years of follow-up 13.35 （ 2.29,4.89 ） , 2.76 （ 2.06,3, 69 ） , 2.41 （1.89,3.08）, 2.22 （1.69,2.91）, 1.99 （1.55,2.55）, respectively]. Compared with TCu220, Medicated γ-25,200 resulted in lower cumulative pregnancy rate after follow-up 2, 3 years [ 0.46 （0.25 ,0.87 ） ; 0.48 （0.27,0. 85 ） ], lower cumulative expulsion rate after 1 year follow-up [ 0. 58 （0.35,0.97） ] , lower cumulative rate of being removed for medical reasons in5 year follow-up [0.37 （0.23,0.59）, 0.38 （0.26,0.56）, 0.45 （0.32,0.64）, 0.47 （0.30,0.73）, 0.58 （0.39,0.87）, respectively ] and higher rate of cumulative continuation in 5 years of follow-up [ 2. 15 （ 1.61,2.87 ）, 2.02 （ 1.56,2.63）, 1.72 （ 1.34,2.20）, 1.44 （ 1.08,1.91 ）, 1, 39 （ 1.07,1.80）, respectively]. Compared with Uterus-Cu, Medicated γ-25,200 resulted in higher rate of cumulative continuation after follow-up 1 year [ 0.51 （0.34, 0.77） ]. Compared with MLCu375, Medicated γ-25,200 resulted in lower cumulative rate of being removed for medical reasons and higher rate of cumulative continuation after follow-up for 3 years [ 0. 22 （0.09,0.52） , 2.84 （ 1.64,4. 94 ）]. Compared with TCu380A, Medicated γ-25, 200 resulted in lower cumulative rate of being removed for medical reasons and higher rate of cumulative continuation in follow-up for 2 years [ 0.36 （ 0.18,0.73 ）, 0.29 （ 0. 12,0.70 ） ; 3.06 （ 1.72,5.44）, 3.61 （1.75,7.47） ]. Conclusions Available evidence shows that Medicated γ-IUD has better or equal effectiveness when compared with other IUDs. However, more RCTs with high quality and longer follow up period are needed to confirm the conclusion.
Objective To investigate the endometrial thickness and echo patterns of healthy women, so as to provide a basis for the formulation of a standard to define normal endometrium in Chinese women. Method A total of 1872 married healthy women in Yongchuan District received transvaginal ultrasound examination. The endometrial sonograph was observed and endometrial thickness was measured for statistical analyses. Results In pre-menopausal women of different age groups, the endometrial thickness was increased and the endometrial echo was enhanced from the proliferative phase, ovulatory phase and secretory phase. The endometrial thickness varied significantly among different menstrual cycles, while no significant difference was observed in the endometrial thickness of a same menstrual cycle among women of different age groups. Pre-menopausal women had significantly different endometrial thickness when compared with post-menopausal women. Conclusion Through a general survey of women by transvaginal ultrasound, a large sample database can be established, which may contribute to the formulation of a standard to define normal endometrium in Chinese women and to help identify abnormal endometrium.
目的：探讨腹腔镜下卵巢子宫内膜异位囊肿保守手术的疗效。方法:2005年1月至2006年7月间采用腹腔镜保守手术治疗卵巢子宫内膜异位囊肿患者106例。患者平均年龄（32.5±6.4）岁，平均病程2.1年。合并不孕症21例，痛经54例，性交痛38例，慢性盆腔痛76例。无明显自觉症状仅以普查发现附件肿物者23例。结果：106例患者中行囊肿剔除术100例（94.3％），其中单侧卵巢内膜异位囊肿剔除61例，双侧卵巢内膜异位囊肿剔除39例（其中双侧囊肿剔除术34例，一侧囊肿剔除而另一侧附件切除5例），单侧附件切除6例。所有患者平均手术时间(38±11)分钟，平均出血量（35.6±12.5）mL。首次排气时间平均在术后（22.3±4.2）小时。平均住院天数（4.2±1.3）天。随访3～18个月，除21例不孕患者均于术后服用内美通或孕三烯酮2.5 mg 2次/周共3～6个月。106例患者中治疗性交痛总有效率92.2％，治疗慢性盆腔痛总有效率92.1％，治疗痛经总有效率90.7％。21例不孕患者中总妊娠率61.9％，7例(53.8％)半年内妊娠，6例（46.2％）1年内妊娠。术后复发9例（8.5％）。结论:对保留生育功能的卵巢子宫内膜异位囊肿患者，腹腔镜下保守手术是目前公认的安全、有效的手术方法。