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Cervical Intraepithelial Neoplasia Managed by Cold Knife Conization with Electrocautery Hemostasis by Hysteroscope: 193 Cases Analysis

Henan DENG ; Wei ZHANG

Journal of Practical Obstetrics and Gynecology.2010;26(4):282-285.

Objective:To evaluate the value of diagnosis and therapy of cold knife conization with electro-cautery hemostasis by hysteroscope in the treatment of ceNical intraepithelial neoplasia (CIN).Methods :A retrospective analysis of the clinical data was carried out in 193 cases with CIN underwent cold knife coniza-tion with electrocautery hemostasis by hysteroscope from January 2005 to November 2008, and all patients had pathological diagnosis under colposcopic biopsy.Results:The operative time was from 15 to 40 mi-nutes, and the blood loss dunng operation was from 5 to 25 milliliters.The coincidence rate of histopathology before and after conization was 67.88% in 131 cases.9 CIN Ⅲ patients had positive margins after opera-tion, owing to scab break off bleeding of cervical wound was encountered in 18 cases.No infection and cervi-cal adhesion or stenosis occurred.Conclusions :Cold knife conization with electrocautery hemostasis by hyst-eroscope is an effective diagnosis and treatment for CIN.

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The Relationship between Decision-to-Delivery Interval in Emergency Caesarean Sections and Neonatal Outcome

Xia LI ; Aiqing HU ; Houwen PANG

Journal of Practical Obstetrics and Gynecology.2010;26(4):276-278.

Objectlve:To assess the influential factors of decision-to-delivery inteval (DDI) in caesarean section, and its influence on neonatal outcomes.Methods:472 caesarean sections were divided into two groups according to Lucas's classification :the emergency caesarean sections as group 1 (291) ; and the e-lective caesarean sections as group 2 (181).It was divided into DDI ≤30 min group and DDI > 30 mir group in group 1.A retrospective study was performed in DDI, influential factors of DDI, neonatal Apgar score and umbilical arterial blood gas.Results: ①The mean DDI was 35.5±11.6 min in group 1,in wgich DDI≤30 min was 210 cases (72.2%) and 49.3 ±22.8 min in group 2, in which DDI≤30 min was 86 cases (47.5%).②IN group 1,umbilical artery pH and Apgar core at 1 min after birth could be improved sigbificantly in the cases of DDI ≤ 30 min (P<0.05) , but no correlation was found between the DDI and Apgar scrore at 5 min ,as compared with DDI ＞30MIN CASES(p＞0.05).③It was mainly influenced by time taken to get the patient into operation room in DDI >30 min (56 cases, 69.1 %).Concluslons :The recommended DDI ≤30 min is not routinely achieved even in emergency caesarean sections.Shortening DDI as far as pos-sible might improve the neonatal outcome.

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Pulmonary Hypertension Complication Pregnancy : Analysis of 10 Cases

Lijuan ZHANG ; Hongbo ZENG

Journal of Practical Obstetrics and Gynecology.2010;26(4):268-271.

Objective:To analysis the clinical characteristics of pulmonary hypertension (PH) complicating pregnancy, then to explore the delivery time and the monitodng as well as the treatment during perinatal peri-od.Methods:The data of 10 cases with PH treated in our hospital from June 2005 to January 2009 were retro-spectively analyzed.Reaults:1 case was primary pulmonary hypertension(PPH) ; 9 cases were secondary PH (SPH), in which 4 cases were rheumatic heart disease and 5 cases were congenital heart diseases.3 cases were slight PH,6 cases were moderate PH, and 1 were severe group.4 cases NYHA class were Ⅰ～Ⅱ and 6 cases NYHA class were Ⅲ～Ⅳ.4 cases were term delivery,5 cases were premature delivery, and 1 got artifi-cial abortion.8 cases were cesarean section, and 1 was vaginal delivery.2 cases were very low birth weight infants, 1 infant was death and 1 mother was death.Conclusions:The patient of PPH should avoid concei-ving.For SPH patients whether to conceive depends on cardiac function, the level of pulmonary arterial pres-sure and should better get pregnancy after surgery or medication.It should terminate pregnancy in the first tri-mester for moderate or severe patients.Cesarean section is more suitable for those in the second or third tri-mester.The prognosis of the mother and neonate depends on several factors.

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Effect of Pregnancy and Delivery on the Pelvic Floor Function

Jian QU ; Xiaowei ZHANG

Journal of Practical Obstetrics and Gynecology.2010;26(4):304-306.

Objective:To investigate the change of petvic floor function in the third trimester of pregnancy and early postpartum.Methods :46 pregnant women in the third trimester in our hosprtal from July to October 2007 were randomly selected.In late pregnancy, 6 ～8 weeks and 12 ～14 weeks after delivery, the incidenca of stress urinary incontinence (SUI) and bladder neck mobility in different stage of puerperium was carried out.They were respectively given score, protectrve pad experiment, ultrasonic testing residual urine and peri-neum ultrasound examination.An anarysis on their.Results :The incidence of SUI that diagnosis by POP-Q or POP-Q combined with pat test was 47.83% ,39.13% respectively in late pregnancy group;21.74% ,15.22% in 6 ～8 weeks after delivery;17.24%.13.7g% in 12 ～14 weeks after delivery.The difference between late pregnancy group and 6～8 waeks after delivery group was statistical significance (P<0.05).There was no significantly difference between 6 ～8 weeks and 12 ～14 weeks after delivery groups(P>0.05).There was significant difference between 6 ～ 8 weeks and 12～14 weeks after delivery group while compared the bladder neck angle[(88.11± 13.36)° vs(82.17 ±10.28)°]with the bladder neck rotation angle[(21.67 ±10.64) ° vs (16.79±8.57) °].Conclusions :Pregnancy and delivery can damage the function of pelvic floor, which has certain rehabilitation after delivery.

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Surgery Intervention of Pregnancy Heart Disease

Fengzhen HAN ; Yang ZHAO ; Cong LU

Journal of Practical Obstetrics and Gynecology.2010;26(3):225-228.

Objective:Surgery intervention and its effect on pregnancy heart disease were explored. Meth-ods:Retrospective review of 34 cases of pregnancy heart disease who needed surgery intervention from Jan, 2000 to Dec,2007 was done. Results:17 patients had percutaneous balloon mitral valve (PBMV) dilatation, the area of mitral valve enlarged markedly postoperatively ( P <0.01 ). 9 patients had open chest surgery un-der extracorpory circulation,7 of them had re-replacement mechanical valve due to mechanical valve throm-bosis. One patient had left atrium mucomamectomy. One patient had Wad's sinus breakout and repairmen. 5 patients had Radiofrequency catheter ablation (RFCA) for supraventricular tachycardia. 3 patients had int-racardiac device (ICD) for Ⅲ grade atrioventicular block. 22 patients had cardiac function as grade Ⅲ～Ⅳ and postoperatively recovered to grade Ⅰ～Ⅱ . All 34 patients were alive after treatment, 23 fetus were alive (67.6%), and no adverse results were found during the follow-up. Conclusions:When patients who had pregnancy heart disease need surgery intervention, individualized treatment plan should be made by multidis-cipline experienced doctors according to different heart disease and cardiac function.

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Analyzing Complications of 73 Cases of Laparoscopic Gynecologic Surgery

Jun QIU ; Yuna GUO ; Huifang ZHONG

Journal of Practical Obstetrics and Gynecology.2010;26(3):212-215.

Objective:The causes, management, and prevention of complications in laparoscopic gyneco-logic surgery were investigated. Methods:A retrospective analysis was done based on clinical data of 8279 cases of laparoscopic gynecologic surgery from January 1996 to December 2008 in this hospital. Results:The complication rate was 0.88% (73/8279). These included five cases intraperitoneal bleeding, five cases injury of ureter, 20 cases abdominal vessel damage, 10 cases vulva emphysema, 25 cases wound healing delay and each one case respectively for stomach injury, bladder injury, secondary abdominal cavity preg-nancy,infection and incision hernia. The occurrence rates of complications between hysteroscopy combined with laparoscopic surgery and pure adnexal surgery were no difference( P >0.05). Compared to adnexal op-erations, there was a significantly higher complication rate in myomectomy and laparoscopic assistant vaginal hysterectomy (P < 0.01 ). Conclusions:Complications of laparoscopic gynecologic surgery are correlated with the difficulty of operation and the skillfulness of operators. In order to reduce complications, careful oper-ation and avoiding over self -confidence are essential.

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Nerve Fibres Distribution in Eutopic Endometrium of Women with Endometriosis

Guangling GUO ; Chunlian ZHANG ; Lihua FENG ; Zhentong WEI ; Li ZHOU ; Shuangyun CHEN

Journal of Practical Obstetrics and Gynecology.2010;26(1):68-70.

Objective:Nerve fibres distribution in the functional layer of endometrium of women with endometdosis was investigated.Methods:Histological sections of endometrial tissue were prepared from endometrialcurettings and hysterectomies performed on women with endometnosis(n=25)and without endometriosis(n=40).Immunohistochemistry was used to detect nerve fibres by highly specific polyclonal rabbit antibody PGP 9.5.The assessment of nerve fibre density was performed bv Image Pro Plus Discovery.Results:Nerve fibres were identified throughout the functional layers of the endometrium in all endometriosis patients,but not found in the functional layer of the endometrium in women without endometriosis(P<0.01).Conclusions:Nerve fibres detectad in the functional layer in all women with endometriosis may have important implications for understanding the generation of pain in these patients.

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Clinical Analysis of 83 Cases of Hyperosmolar Glucose in Prevention of Persistent Ectopic Pregnancy after Laparoscopic Salpingostomy

Xiuqing WEI ; Lan GAO ; Hong LIANG

Journal of Practical Obstetrics and Gynecology.2010;26(1):63-65.

Objective: Medical therapy to prevent persistent ectopic pregnancy (PEP) after conservative laparoscopic operation was investigated. Methods:236 patients with ectopic pregnancy were divided into three groups according to the time of hospitalization. 83 cases were in group A, hyperosmolar glucose was injected into the fallopian tube lumen after laparoscopic salpingostomy. 81 cases were in group B, MTX was injected in the same way, 72 cases were in group C as control group. Serum β-HCG was tested for four times, before the operation, the first, third and a week after the operation respectively. Results:There were 6 patients of PEP in this study. One patient in group A, one patient in group B, the rest four patients in group C. The incidence of PEP was not statistically significant between group A and B( P>0. 05), while the difference was significant between group A and C ( P<0. 05). Serum β-HCG in three groups descended significantly in the first 24 hours after operation, but there were no differences among these groups. As for the descending of β-HCG in day 3 and 7, there was no difference between group A and B, but the difference was magnificent between group A and C( P < 0.05). Conclusions: Compared with the MTX, hyperosmolar glucose is an effective and safer method to prevent PEP.

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The Effect of Cervical Canal Mucosa Ring Excision on Cervical Columnar Eversion in Loop Electrosurgical Excision Procedure

Jieying CHEN ; Hongmei ZHOU ; Hong CHEN

Journal of Practical Obstetrics and Gynecology.2010;26(1):61-63.

Objective:To study the effect of cervical canal mucosa dng excision on cervical columnar eversion in Loop electrosurgical excision procedure(LEEP).Methods:A prospective randomized control trail was performed in 125 cervical intraepithelial neoplasia(CIN)patients.Cervix and cervical canal were conically excised with triangle electrode in 62 patients in the control group;in the study group,a small ring electrode was put into the cervical canal and the cervical canal mucosa was excised about 0.5～0.8cm,after excision as the control group.Follow-up was performed postoperatively in 1,3,6 months respectively.The operation time,the bleeding volume,the rate of cervical columnar eversion and cervical adhesion or stenosis were compared between the two groups.Results:The rate of cervical columnar eversion in the study group (1/63,1.59%)was lower than that in the control group(9/62,14.52%).There was significantly statistical difference between them(P=0.008).There was no statistical differences between them in the operation time,the bleeding volume,and the rate of cervical adhesion or stenosis (P>0.05).Conclusions:The cervical canal mucosa ring excision in LEEP can effectively prevent postoperative cervical columnar eversion.

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Short Term Results of Laparoscopic or Laparotomy Radical Hysterectomy and Pelvic Lymphadenectomy for Early Uterine Malignancy

Yi SHEN ; Zehua WANG

Journal of Practical Obstetrics and Gynecology.2010;26(1):48-51.

Objective:The short term results of laparoscopic radical hysterectomy and pelvic lymph nodes dissection for early uterine malignancy were investigated.Methods:70 patients with eady malignant uterine tumor who underwent a laparoscopic radical hysterectomy and pelvic lymph nodes dissection(TLRH+LPL)were retrospectively reviewed.At the samt time,48 patients were recruited to be the control group who had laparotomy radical hysterectomy and pelvic lymph nodes dissection(ARH+APL).Intraoperative and postoperative situations and complications between these two groups were analyzed.Results:70 patients underwent laparoscopic operation,but two cases changed to laparotomy(transfer rate 2.9%).The mean operation time,blood loss,number of dissected pelvic lymph nodes and postoperative temperature recovery time of TLRH+LPL group was significantly different from ARH+APL group(P<0.01),while there were no difference between these two groups on bladder function recovery time and occurance of postoperative complications.Conclusions:TLRH+LPL has the same feasibility and safety with ARH+APL,less invasive to the tissue,thus offers a good option of microinvasive therapy for female malignant tumor.

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