Objective To investigate the influencing factors of pregnancy outcomes after transcervical resection of polyp(TCRP)in infertility patients.Methods The data of 442 patients with infertility complicated with endometrial polyp(EP)underwent TCRP from March 2021 to March 2022 were retrospectively analyzed,and the postoperative follow-up time was 12-24 months,and they were divided into postoperative pregnancy group(pregnancy group)and non-pregnant group(control group).The two groups were compared with age,body mass index(BMI),infertility type,abnormal uterine bleeding,adverse pregnancy history,number of EP,EP size,intraoperative negative pressure uterine aspiration,endometritis,TCRP operation time,and uterine cavity depth,and multivariate analysis was conducted on the influencing factors of pregnancy outcomes after TCRP in infertility patients.Results Among 442 infertility patients with EP,274 cases(62.0%)were in the pregnancy group and 168 cases(38%)in the control group.The factors influencing pregnancy after TCRP were age(OR=0.925,95%CI:0.881-0.972,P<0.05),abnormal uterine bleeding before surgery(OR=0.646,95%CI:0.432-0.967,P<0.05)and primary infertility(OR=2.105,95%CI:1.295-3.423,P<0.05).Conclusion TCRP can improve pregnancy outcomes in infertility patients with EP.Age and abnormal uterine bleeding before operation were the protective factors to increase pregnancy after TCRP in infertility patients.Primary infertility is a risk factor for pregnancy after TCRP in infertility patients.

Objective To establish a method for predicting the risk of endometrial cancer(EC)and endometrial atypical hyperplasia(AH)in women with postmenopausal bleeding(PMB)by collecting clinical data on routine medical history.Methods The clinical data of a total of 408 PMB patients admitted to Fuxing Hospital,Capital Medical University were consecutively collected in this retrospective study from December 2013 to December 2023.According to the results of endometrial pathology,patients were divided into case group and control group.EC and AH were included in the malignant group(case group)and the other endometrial pathologies were included in the non-malignant group(control group).Clinical data,including clinical history,high risk factors,and common gynecological ultrasound measurement indicators,were collected and studied by univariate and multivariate Logistic regression analysis.Results The mean age of 408 patients was(60.4±7.8)years.A total of 74 cases(18.1％)were in case group and 334 cases(81.9％)were in control group.Based on Logistic regression analysis,the best predictors of endometrial malignant lesions were selected to create a"LRDNT"(light bleeding,recurrent bleeding,diabetes,non-uniform echogenicity & thickness)model.LRDNT scores range from 0 to 22.The score of LRDNT ≥15 has the largest Yoden index,and the sensitivity to predict endometrial malignant lesions is 79.73％,the specificity is 80.84％,and the prediction accuracy is 80.64％.Conclusions The risk prediction model LRDNT,which combines clinical information and common gynecological ultrasound measurement indicators of PMB patients,can help clinicians classify patients at high and low risk of endometrial malignant lesions,and optimize the strategy of diagnosis and treatment.

Objective To investigate the influencing factors of pregnancy outcomes after transcervical resection of polyp(TCRP)in infertility patients.Methods The data of 442 patients with infertility complicated with endometrial polyp(EP)underwent TCRP from March 2021 to March 2022 were retrospectively analyzed,and the postoperative follow-up time was 12-24 months,and they were divided into postoperative pregnancy group(pregnancy group)and non-pregnant group(control group).The two groups were compared with age,body mass index(BMI),infertility type,abnormal uterine bleeding,adverse pregnancy history,number of EP,EP size,intraoperative negative pressure uterine aspiration,endometritis,TCRP operation time,and uterine cavity depth,and multivariate analysis was conducted on the influencing factors of pregnancy outcomes after TCRP in infertility patients.Results Among 442 infertility patients with EP,274 cases(62.0%)were in the pregnancy group and 168 cases(38%)in the control group.The factors influencing pregnancy after TCRP were age(OR=0.925,95%CI:0.881-0.972,P<0.05),abnormal uterine bleeding before surgery(OR=0.646,95%CI:0.432-0.967,P<0.05)and primary infertility(OR=2.105,95%CI:1.295-3.423,P<0.05).Conclusion TCRP can improve pregnancy outcomes in infertility patients with EP.Age and abnormal uterine bleeding before operation were the protective factors to increase pregnancy after TCRP in infertility patients.Primary infertility is a risk factor for pregnancy after TCRP in infertility patients.

Objective To establish a method for predicting the risk of endometrial cancer(EC)and endometrial atypical hyperplasia(AH)in women with postmenopausal bleeding(PMB)by collecting clinical data on routine medical history.Methods The clinical data of a total of 408 PMB patients admitted to Fuxing Hospital,Capital Medical University were consecutively collected in this retrospective study from December 2013 to December 2023.According to the results of endometrial pathology,patients were divided into case group and control group.EC and AH were included in the malignant group(case group)and the other endometrial pathologies were included in the non-malignant group(control group).Clinical data,including clinical history,high risk factors,and common gynecological ultrasound measurement indicators,were collected and studied by univariate and multivariate Logistic regression analysis.Results The mean age of 408 patients was(60.4±7.8)years.A total of 74 cases(18.1％)were in case group and 334 cases(81.9％)were in control group.Based on Logistic regression analysis,the best predictors of endometrial malignant lesions were selected to create a"LRDNT"(light bleeding,recurrent bleeding,diabetes,non-uniform echogenicity & thickness)model.LRDNT scores range from 0 to 22.The score of LRDNT ≥15 has the largest Yoden index,and the sensitivity to predict endometrial malignant lesions is 79.73％,the specificity is 80.84％,and the prediction accuracy is 80.64％.Conclusions The risk prediction model LRDNT,which combines clinical information and common gynecological ultrasound measurement indicators of PMB patients,can help clinicians classify patients at high and low risk of endometrial malignant lesions,and optimize the strategy of diagnosis and treatment.

Objective To observe the efficacy of Foley balloon combining with uterine adhesions to prevent the recurrence of intrauterine adhesions after resection of intrauterine adhesions.Methods Patients underwent resection of intrauterine adhesions were randomized into two groups. 30 patients in control group underwent the therapy of uterine adhesions to prevent the relapse intrauterine. On the other hand, the study group with 30 patients were placed Foley balloon for 5 ~ 7 days and combined with the therapy of uterine adhesions to intervention for 1 ~ 2 weeks. All patients were followed-up for 1 ~ 2 months, and the result of the intrauterine adhesion were assessed by hysteroscopy.Results The rate of the relapse in control group was 3.33%; the study group had the same result (the rate was 3.33%). There was no difference between these two groups.Conclusions The rate of recurrent intrauterine adhesions is no different between the control group of only use therapy of uterine adhesions and replacement of Foley balloon combining with therapy of uterine adhesions as intervention.

Objective To study the reproductive outcome of infertile women suffered from hydrosalpinx treated by laparoscopic salpingostomy or salpingectomy.Methods There were 77 infertile women diagnosed hydrosalpinx by HSG or B ultrasonography and excepted for other infertile factors. Unilateral or bilateral salpingostomy or salpingectomy was performed after hydrosalpinx conifrmed by laparoscopy. Seventy seven patients were followed up for 1 ~ 4 years postoperatively.Results Among 77 cases 39 cases (50.65%) got pregnancy. Thirteen cases (16.88%) conceived spontaneously and 26 cases (33.77%) conceived by IVF-ETin. Thirty ifve cases delivered health babies and 3 cases of pregnancy, 1 cases of early abortion.Conclusion Both laparoscopic surgeries were effective treatment of hydrosalpinx results in infertility. After operation the pregnant rate of those conceived by IVF-ET is higher than spontaneously.

ObJective To investigate the efficacy of different treatments applied to infertility patients with u-terine septa undergoing transcervical resection of septa to prevent the post-operation adhesion. Methods 55 infertili-ty patients with uterine septa underwent laparoscopy guidance transcervical resecition of septa(TCRS), different treatments were given to the patients post-operation, including placement of IUD in uterus cavity or not, artificial cy-cle treatment, GnRH-a medication using post-operation, hysteroscopy examination was performed for the first and third month post surgery and IUD was taken out in the third month post surgery. Results Total 54 eases completed hysteroscopy examination follow-up visits,of which 40 cases completed total two times of hysteroscopy in the first and third month, and 14 eases completed only once hysteroscopy examination. Whether or not placement of IUD hadno effect on uterus cavity shape(P > 0.05). Compared to eases without using artificial cycle treatment post-opera-tion, the endometrium was thicker in the cases with it post-operation. Both cases using and not using artificial cycle treatment were found to have endometrium covered in fundus under hysteroscopy in the third month post-operation.The satisfactory cavity shape was achieved on patient receiving GnRH-a medication. Conclusion Placement of IUD is not helpful in preventing the occurrence of post-operation adhesions. Individualized post-operation artificial cycle treatments should be applied to different patients and using GnRH-a medication should be in right direction. The hysteroscopy examination post-surgery should be given in time to prevent the new occurrence of adhesion in fundus post-operation.

Objective To evaluate clinical effects of combined use of hysteroscopy and laparoscopy in the diagnosis and treatment of infertility with uterine septum,and to analyze the relationship between infertility and uterine septum. Methods Surgery using hysteroscopy combined with laparoscopy was performed in 110 patients with infertility accompanying uterine septum,including primary infertility in 78 patients and secondary infertility in 32 patients.The relative infertility factors and post-operative pregnancy prognoses were analyzed. Results Unexplained infertility accounted for 40% of patients(44/110).As of March 2006,a total of 82 patients were successfully followed.The total post-operative pregnancy rate was 45.1%(37/82),consisting of 46.6% in patients with primary infertility(27/58) and 41.7% in patients with secondary infertility(10/24),without significant difference between the two groups(?~2=0.164,P=0.686).The post-operative pregnancy rates in patients with unexplained infertility and etiologically-clarified infertility were 51.2%(22/43) and 38.5%(15/39),respectively,without significant difference(?~2=1.332,P=0.248).In patients with unexplained infertility,the post-operative pregnancy rate for primary infertility was 56.7%(17/30) and for secondary infertility,38.5%(5/13). Conclusions Combined use of hysteroscopy and laparoscopy for infertility with uterine septum can improve the post-operative pregnancy rate.The presence of uterine septum bears some relationship to the incidence of infertility.

OBJECTIVETo evaluate transcervical removal of foreign bodies (TCRF) and to estimate the effectiveness of its monitoring methods.

METHODSOne hundred and thirteen women were identified as having residual intrauterine devices (IUD), residual pregnancy products, unabsorbed strings and broken hooks, which were not removed during routine curettage or IUD removal. All patients were monitored using B ultrasonography while TCRF was performed. Four cases were monitored by laparoscopy simultaneously. One case was monitored by laparoscopic ultrasonography.

RESULTSForeign bodies of one hundred and nine patients were taken out by TCRF. Uterine bleeding, amenorrhoea, discharge, abdominal pain, micturition and hematuria disappeared postoperatively. Fetal bones embedded into intramural uterin in four cases were not removed completely. Of these four, one became pregnant 4 months later after TCRF and term delivered. One case encountered uterine perforation that was sutured by laparoscopy.

CONCLUSIONSTCRF is safe and efficient. Sufficient cervical canal distension, selection of equipment and methods to be used is important for successful TCRF. As a non-invasive and effective monitoring method, B ultrasonography is the first choice to monitor for TCRF. For patients with high risk factors for uterine perforation, laparoscopic monitoring should be done simultaneously. Laparoscopic ultrasonography monitoring has both the advantages of B ultrasonography and laparoscopy monitoring, but is invasive and expensive.

Adult ; Aged ; Female ; Foreign Bodies ; diagnostic imaging ; surgery ; Humans ; Hysteroscopy ; methods ; Intrauterine Devices ; Laparoscopy ; Middle Aged ; Pregnancy ; Ultrasonography

Objective To investigate the causations, management and prevention methods on the complications of hysteroscopic procedures. Methods Retrospective analysis of 36 cases with hysteroscopic complication, focusing on their characteristics and clinical management as well as prevention methods during the ten years from 1993 to 2004. Results Among 36 cases, 11 cases with uterine perforation and incomplete perforation, which happened during the complicated procedures, were treated by both laparoscopy and laparotomy. Five cases with heavy bleeding were encountered because of the deeply injury to the uterine wall and Foley catheter was inserted into uterine cavity and it stopped the bleeding successfully except in one case done by hysterectomy. Three cases with fluid overload syndrome were cured by using diuretic agent and saline infusion. There is no serious consequence in one case with air embolism due to prompt diagnosis and treatment. Four cases with postablation-sterilization syndrome were treated effectively by performing hysterectomy plus single or bilateral salpingectomy, dilating cervical canal as well as resecting adhesions. Twelve cases with adhesion inside uterine cavity followed hysteroscopy were also treated by dilating cervical canal, underwent adhesionlysis and hysterectomy. Conclusions The potential factors causing complications of hysteroscopy include complicated procedures inside uterine cavity, higher pressure of irrigation, deep injury of endometrium as well as incomplete removal of endometrium during hysteroscopic operations. It is the necessary measures to reduce the complications by performing laparoscopy or B ultrasound monitoring simultaneously, standardizing the procedure and strengthening postoperation management.