Objective To investigate the application of hysteroscopy in pathological changes of infertility uterus. Methods The clinical data of 226 cases of infertility females receiving hysteroscopy from January 2007 to June 2009 in Sichuan Provincial Hospital for Women and Children were retrospectively analyzed. Results In 226 cases, hysteroscopic examination identified 147 cases of intrauterine diseases (65.04%), including 56 cases of intrauterine adhesion (24.78%), 32 cases of endometritis (14.16%), 27 cases of endometrial polyps (11.94%), 15 cases of uterine malformation (6.64%), 9 cases of submucous myoma (3.98%), 3 cases of endometrial tuberculosis (1.33%), 3 cases of uterus cavity narrow (1.33%), 2 cases of cervical internal relaxation (0.88%). No postoperative complications occurred, except for a small amount of vaginal bleeding. Conclusion For the diagnosis of the pathological changes in uterus, hysteroscopy is a direct and accurate method with less operative duration, less trauma, less pain, quick recovery, no complications, and no necessity for hospitalization. It is worth to be popularized.
【摘要】 目的 分析宫腔镜联合腹腔镜在不孕症诊治中的应用和意义。 方法 回顾性分析2007年1月-2009年12月采用宫腔镜联合腹腔镜手术诊治92例女性不孕症患者的临床资料。 结果 92例中原发不孕39例，继发不孕53例；其中有盆腔病变者86例，占93.5%。不孕原因居前四位分别是盆腔粘连31例（33.7%），输卵管阻塞24例（26.1%），子宫内膜异位症10例（10.9%），子宫内膜息肉8例（8.7%）。输卵管阻塞24例行宫腔镜引导下单极电凝器钝性逆行分离术或造口术，有20例输卵管复通，复通率66.7%。术后6~12个月年随访，妊娠率为19.6%（18/92），其中宫内妊娠15例，宫外孕3例。 结论 腹腔镜联合宫腔镜检查能快速准确地明确女性不孕的确切原因及部位，并可采取针对性治疗措施，是目前诊治不孕症的可靠方法。【Abstract】 Objective To investigate the application and role of laparoscopy combined with hysteroscopy in the diagnosis and treatment of infertile patients. Methods Ninety-two patient with infertility who examined and treated with laparoscopy combined with hysteroscopy in this hospital were retrospectively analyzed from January 2007 to December 2009. Results There were 39 patients with primary infertility and 53 patients with secondary infertility.The main reason of infertility was pelvic diseases (93.5%). In the pelvic diseases,the common causes included pelvic adhesion (31 cases, 33.7%), obstruction of oviduct (24 cases, 26.1%), endometriosis (10 cases, 10.9%), and endometrial polyp (8 cases, 8.7%). Twenty-four patients with obstruction of oviduct were treated with hysteroscopy conducting unipolar electrocoagulation tool, 20 fallopian tubes were unobstructed. The recover rate was 66.7%. All the patients received follow-up by 6 - 12 months, and the pregnancy rate was 19.6% (18/92). Out of these 18 patients, 15 patients were intrauterine and 3 extrauterine. Conclusion Laparoscopy combined with hysteroscopy can find out the exact reasons of infertility and offer the respective treatment, and be a reliable method to diagnose and treat infertility patient.
目的:探讨宫内节育器(IUD)异位的临床诊治方法。方法:对37例宫内节育器异位的临床资料进行回顾性分析。结果:所有37例IUD异位者均经宫、腹腔镜取器成功。结论:及时诊断并通过宫腹腔镜取器直观、安全、微创、有效。
Objectives To analyze the efficacy and safety of different operation methods for patients with cesarean scar diverticulum. Methods The clinical data of patients with cesarean section scar diverticulum treated in West China Second University Hospital from July 2012 to December 2016 was collected and followed up. The data of the previous perioperative period data, recovery, the improvement of the symptoms and postoperative condition of incision healing were analyzed by SPSS 22.0 software. Results A total of 125 patients were included, in which 74 cases received hysteroscopy surgery for diverticulum electro section and electric coagulation (ESEC group), and 51 cases received other surgery focused on diverticulum dissection and sewing operations (DS group). Statistical analysis showed that, compared with DS group, bleeding, operation time, time of anal exsufflation and hospitalization duration after the operation of hysteroscopy in ESEC group were significantly reduced (P<0.001). In addition, the results showed that hysteroscopy group had optimal results in hemorrhage volume, operation time, anal exhaust time and hospitalization time indicators. However, the results of laparotomy group was not significant. Conclusions For the treatment of CSD, surgical treatment of this pathology by operative hysteroscopy may represent the best choice in symptomatic women because of its minimal invasiveness and beneficial therapeutic results. Hysteroscopy isthmoplasty appears to be the most popular treatment.
ObjectiveTo summarize and explore the clinical management and practical effect of ambulatory hysteroscopic surgery.MethodsThe annual operation volume, disease types, three- and four-grade operation proportion, complications, hospitalization expenses, patient satisfaction and average length of hospital stay of patients undergoing ambulatory hysteroscopic surgery in the First Affiliated Hospital of Chongqing Medical University between September 2014 and August 2019 were retrospectively analyzed.ResultsA total of 5 446 patients underwent hysteroscopic surgery during the five-year period, of whom 569 cases underwent the operation in conventional hospitalization mode in the first year and 4 877 cases did in ambulatory mode in the following four years. The quantity of hysteroscopy operations increased by stages (P<0.001) and the structure of disease types was optimized. The proportion of three- and four-grade complex operations increased from 48.15% to 79.15% stage by stage in ambulatory mode (P<0.05); ambulatory hysteroscopic surgery was proved to be safe and controllable with a low incidence of complications [0.43% (21/4 877)]; the average hospitalization cost of the patients was significantly lower than that of the conventional hospitalization mode (P<0.05); the score of patient satisfaction increased from 92.90±1.77 to 94.57±2.11 compared with the conventional hospitalization mode, and increased further with the construction of the specialized platform to 96.19±2.24 (P<0.05); the average length of hospital stay in ambulatory mode was significantly shortened than that in conventional hospitalization mode (P<0.05).ConclusionHysteroscopic surgery in ambulatory mode can improve the efficiency of medical services, ensure patient safety, improve patient satisfaction, reduce the average length of hospital stay, and reduce the economic burden of patients, so it could be widely promoted and standardized in clinical practice.
Objective To explore the clinical effect of intramuscular injection of methotrexate on hysteroscopic treatment of endogenous cesarean scar pregnancy (CSP). Methods A prospective analysis was conducted on 94 patients diagnosed with endogenous CSP who visited the Department of Gynecology in Liuzhou Workers’ Hospital between January 2013 and January 2018, and they were randomly divided into two groups, the intramuscular injection of methotrexate followed by hysteroscopic surgery group (the methotrexate group, n=39) and the direct hysteroscopic surgery group (the non-methotrexate group, n=55). The operation time, intraoperative blood loss, surgical complications, length of hospital stay, hospitalization expenses, the recovery time of blood human chorionic gonadotropin (HCG) and treatment outcomes of the two groups were compared. The normally distributed data were expressed as mean±standard deviation, and the non-normally distributed data were expressed as median (lower quartile, upper quartile). Results There was no statistically significant difference in age, gestational sac diameter, uterine scar thickness, number of cesarean sections, time from cesarean section to present, time of menopause, or preoperative blood HCG value between the two groups (P>0.05). There was no statistically significant difference in intraoperative blood loss [75 (35, 120) vs. 65 (35, 130) mL, P=0.821], incidence of complications (5.1% vs. 5.5%, P=1.000), postoperative blood HCG recovery time [(5.22±2.17) vs. (4.96±1.81) weeks, P=0.559] or the effective rate of treatment (94.9% vs. 90.9%, P=0.747) between the two groups. The methotrexate group had longer operation time [43 (34, 55) vs. 32 (28, 35) min, P=0.001], longer length of hospital stay [(10.89±1.42) vs. (5.82±1.47) d, P<0.001], and higher hospitalization cost [(8596.46±3336.59) vs. (7058.84±2638.49) yuan, P=0.014]. Conclusion For patients with endogenous CSP, intramuscular injection of methotrexate before hysteroscopic surgery is not necessary, for it has no significant impact on the treatment effect, instead, it may prolong the operation time and length of hospital stay, and increase the hospitalization cost.