Objective:To explore the effects of different surgical methods on the treatment outcomes and prog-nosis in patients with caesarean section scar pregnancy(CSP).Methods:A total of 90 patients with type n or ⅢCSP admitted to Department of Obstetrics and Gynecology,Affiliated Hospital of Jinggangshan University be-tween February 1,2021 and February 1,2022 were selected as the study subjects.They were enrolled in order of inclusion,exclusion criteria,and admission treatment time.According to different treatment methods,they were di-vided into group A(30 cases),group B(30 cases)and group C(30 cases).The group A underwent laparoscopic uterine artery ligation(UAL)+focus excision and repair of scar pregnancy(FER)+uterine cicatricial repair(UCR),group B underwent uterine artery embolization(UAE)+hysteroscopic FER under ultrasonic monitoring,and group C underwent laparoscopic FER+UCR.The intraoperative and postoperative conditions,as well as the incidence of recurrent CSP(RCSP)rate and repregnancy rate during follow-up in the three groups were com-pared.Results:① The intraoperative blood loss,postoperative uterine drainage volume and postoperative VAS score in groups A and B were lower than those in group C,while the operation time and hospitalization cost were higher than those in group C(P＜0.05).The operation time and hospitalization cost in group A were lower than those in group B(P＜0.05).②The postoperative vaginal hemostasis time,menstrual recovery time and recovery time of serum β-human chorionic gonadotropin(β-HCG)in groups A and B were shorter than those in group C(P＜0.05).③There was no statistically significant difference in the incidence of postoperative complications such as adhesion,infection,severe bleeding,and lower abdominal pain among the three groups(P＞0.05).④The mean follow-up time after surgery was(17.60±5.61)months,and the incidence of RCSP in group A and group C was lower than that in group B(P＜0.05).The rate of repregnancy in group A,group B and group C was 82.14％(23/28),77.78％(21/27)and 81.48％(22/27),respectively,and there was no significant difference in the rate of repregnancy among the three groups(P＞0.05).Conclusions:Laparoscopic UAL+FER+UCR and UAE+ultrasound monitoring hysteroscopic FER can reduce intraoperative bleeding and promote postoperative re-covery,but the surgery time is prolonged and hospitalization costs are higher;After using UCR treatment,the inci-dence of RCSP is lower.Clinical evaluation should be based on the specific condition,economic conditions,and need to preserve fertility of type Ⅱ and Ⅲ CSP patients,and personalized treatment plans should be developed.

Objective:To explore the effects of different surgical methods on the treatment outcomes and prog-nosis in patients with caesarean section scar pregnancy(CSP).Methods:A total of 90 patients with type n or ⅢCSP admitted to Department of Obstetrics and Gynecology,Affiliated Hospital of Jinggangshan University be-tween February 1,2021 and February 1,2022 were selected as the study subjects.They were enrolled in order of inclusion,exclusion criteria,and admission treatment time.According to different treatment methods,they were di-vided into group A(30 cases),group B(30 cases)and group C(30 cases).The group A underwent laparoscopic uterine artery ligation(UAL)+focus excision and repair of scar pregnancy(FER)+uterine cicatricial repair(UCR),group B underwent uterine artery embolization(UAE)+hysteroscopic FER under ultrasonic monitoring,and group C underwent laparoscopic FER+UCR.The intraoperative and postoperative conditions,as well as the incidence of recurrent CSP(RCSP)rate and repregnancy rate during follow-up in the three groups were com-pared.Results:① The intraoperative blood loss,postoperative uterine drainage volume and postoperative VAS score in groups A and B were lower than those in group C,while the operation time and hospitalization cost were higher than those in group C(P＜0.05).The operation time and hospitalization cost in group A were lower than those in group B(P＜0.05).②The postoperative vaginal hemostasis time,menstrual recovery time and recovery time of serum β-human chorionic gonadotropin(β-HCG)in groups A and B were shorter than those in group C(P＜0.05).③There was no statistically significant difference in the incidence of postoperative complications such as adhesion,infection,severe bleeding,and lower abdominal pain among the three groups(P＞0.05).④The mean follow-up time after surgery was(17.60±5.61)months,and the incidence of RCSP in group A and group C was lower than that in group B(P＜0.05).The rate of repregnancy in group A,group B and group C was 82.14％(23/28),77.78％(21/27)and 81.48％(22/27),respectively,and there was no significant difference in the rate of repregnancy among the three groups(P＞0.05).Conclusions:Laparoscopic UAL+FER+UCR and UAE+ultrasound monitoring hysteroscopic FER can reduce intraoperative bleeding and promote postoperative re-covery,but the surgery time is prolonged and hospitalization costs are higher;After using UCR treatment,the inci-dence of RCSP is lower.Clinical evaluation should be based on the specific condition,economic conditions,and need to preserve fertility of type Ⅱ and Ⅲ CSP patients,and personalized treatment plans should be developed.

Objective:To explore the effects of different surgical methods on the treatment outcomes and prog-nosis in patients with caesarean section scar pregnancy(CSP).Methods:A total of 90 patients with type n or ⅢCSP admitted to Department of Obstetrics and Gynecology,Affiliated Hospital of Jinggangshan University be-tween February 1,2021 and February 1,2022 were selected as the study subjects.They were enrolled in order of inclusion,exclusion criteria,and admission treatment time.According to different treatment methods,they were di-vided into group A(30 cases),group B(30 cases)and group C(30 cases).The group A underwent laparoscopic uterine artery ligation(UAL)+focus excision and repair of scar pregnancy(FER)+uterine cicatricial repair(UCR),group B underwent uterine artery embolization(UAE)+hysteroscopic FER under ultrasonic monitoring,and group C underwent laparoscopic FER+UCR.The intraoperative and postoperative conditions,as well as the incidence of recurrent CSP(RCSP)rate and repregnancy rate during follow-up in the three groups were com-pared.Results:① The intraoperative blood loss,postoperative uterine drainage volume and postoperative VAS score in groups A and B were lower than those in group C,while the operation time and hospitalization cost were higher than those in group C(P＜0.05).The operation time and hospitalization cost in group A were lower than those in group B(P＜0.05).②The postoperative vaginal hemostasis time,menstrual recovery time and recovery time of serum β-human chorionic gonadotropin(β-HCG)in groups A and B were shorter than those in group C(P＜0.05).③There was no statistically significant difference in the incidence of postoperative complications such as adhesion,infection,severe bleeding,and lower abdominal pain among the three groups(P＞0.05).④The mean follow-up time after surgery was(17.60±5.61)months,and the incidence of RCSP in group A and group C was lower than that in group B(P＜0.05).The rate of repregnancy in group A,group B and group C was 82.14％(23/28),77.78％(21/27)and 81.48％(22/27),respectively,and there was no significant difference in the rate of repregnancy among the three groups(P＞0.05).Conclusions:Laparoscopic UAL+FER+UCR and UAE+ultrasound monitoring hysteroscopic FER can reduce intraoperative bleeding and promote postoperative re-covery,but the surgery time is prolonged and hospitalization costs are higher;After using UCR treatment,the inci-dence of RCSP is lower.Clinical evaluation should be based on the specific condition,economic conditions,and need to preserve fertility of type Ⅱ and Ⅲ CSP patients,and personalized treatment plans should be developed.

Objective:To explore the effects of different surgical methods on the treatment outcomes and prog-nosis in patients with caesarean section scar pregnancy(CSP).Methods:A total of 90 patients with type n or ⅢCSP admitted to Department of Obstetrics and Gynecology,Affiliated Hospital of Jinggangshan University be-tween February 1,2021 and February 1,2022 were selected as the study subjects.They were enrolled in order of inclusion,exclusion criteria,and admission treatment time.According to different treatment methods,they were di-vided into group A(30 cases),group B(30 cases)and group C(30 cases).The group A underwent laparoscopic uterine artery ligation(UAL)+focus excision and repair of scar pregnancy(FER)+uterine cicatricial repair(UCR),group B underwent uterine artery embolization(UAE)+hysteroscopic FER under ultrasonic monitoring,and group C underwent laparoscopic FER+UCR.The intraoperative and postoperative conditions,as well as the incidence of recurrent CSP(RCSP)rate and repregnancy rate during follow-up in the three groups were com-pared.Results:① The intraoperative blood loss,postoperative uterine drainage volume and postoperative VAS score in groups A and B were lower than those in group C,while the operation time and hospitalization cost were higher than those in group C(P＜0.05).The operation time and hospitalization cost in group A were lower than those in group B(P＜0.05).②The postoperative vaginal hemostasis time,menstrual recovery time and recovery time of serum β-human chorionic gonadotropin(β-HCG)in groups A and B were shorter than those in group C(P＜0.05).③There was no statistically significant difference in the incidence of postoperative complications such as adhesion,infection,severe bleeding,and lower abdominal pain among the three groups(P＞0.05).④The mean follow-up time after surgery was(17.60±5.61)months,and the incidence of RCSP in group A and group C was lower than that in group B(P＜0.05).The rate of repregnancy in group A,group B and group C was 82.14％(23/28),77.78％(21/27)and 81.48％(22/27),respectively,and there was no significant difference in the rate of repregnancy among the three groups(P＞0.05).Conclusions:Laparoscopic UAL+FER+UCR and UAE+ultrasound monitoring hysteroscopic FER can reduce intraoperative bleeding and promote postoperative re-covery,but the surgery time is prolonged and hospitalization costs are higher;After using UCR treatment,the inci-dence of RCSP is lower.Clinical evaluation should be based on the specific condition,economic conditions,and need to preserve fertility of type Ⅱ and Ⅲ CSP patients,and personalized treatment plans should be developed.

Objective:To explore the effects of different surgical methods on the treatment outcomes and prog-nosis in patients with caesarean section scar pregnancy(CSP).Methods:A total of 90 patients with type n or ⅢCSP admitted to Department of Obstetrics and Gynecology,Affiliated Hospital of Jinggangshan University be-tween February 1,2021 and February 1,2022 were selected as the study subjects.They were enrolled in order of inclusion,exclusion criteria,and admission treatment time.According to different treatment methods,they were di-vided into group A(30 cases),group B(30 cases)and group C(30 cases).The group A underwent laparoscopic uterine artery ligation(UAL)+focus excision and repair of scar pregnancy(FER)+uterine cicatricial repair(UCR),group B underwent uterine artery embolization(UAE)+hysteroscopic FER under ultrasonic monitoring,and group C underwent laparoscopic FER+UCR.The intraoperative and postoperative conditions,as well as the incidence of recurrent CSP(RCSP)rate and repregnancy rate during follow-up in the three groups were com-pared.Results:① The intraoperative blood loss,postoperative uterine drainage volume and postoperative VAS score in groups A and B were lower than those in group C,while the operation time and hospitalization cost were higher than those in group C(P＜0.05).The operation time and hospitalization cost in group A were lower than those in group B(P＜0.05).②The postoperative vaginal hemostasis time,menstrual recovery time and recovery time of serum β-human chorionic gonadotropin(β-HCG)in groups A and B were shorter than those in group C(P＜0.05).③There was no statistically significant difference in the incidence of postoperative complications such as adhesion,infection,severe bleeding,and lower abdominal pain among the three groups(P＞0.05).④The mean follow-up time after surgery was(17.60±5.61)months,and the incidence of RCSP in group A and group C was lower than that in group B(P＜0.05).The rate of repregnancy in group A,group B and group C was 82.14％(23/28),77.78％(21/27)and 81.48％(22/27),respectively,and there was no significant difference in the rate of repregnancy among the three groups(P＞0.05).Conclusions:Laparoscopic UAL+FER+UCR and UAE+ultrasound monitoring hysteroscopic FER can reduce intraoperative bleeding and promote postoperative re-covery,but the surgery time is prolonged and hospitalization costs are higher;After using UCR treatment,the inci-dence of RCSP is lower.Clinical evaluation should be based on the specific condition,economic conditions,and need to preserve fertility of type Ⅱ and Ⅲ CSP patients,and personalized treatment plans should be developed.

Objective:To explore the effects of different surgical methods on the treatment outcomes and prog-nosis in patients with caesarean section scar pregnancy(CSP).Methods:A total of 90 patients with type n or ⅢCSP admitted to Department of Obstetrics and Gynecology,Affiliated Hospital of Jinggangshan University be-tween February 1,2021 and February 1,2022 were selected as the study subjects.They were enrolled in order of inclusion,exclusion criteria,and admission treatment time.According to different treatment methods,they were di-vided into group A(30 cases),group B(30 cases)and group C(30 cases).The group A underwent laparoscopic uterine artery ligation(UAL)+focus excision and repair of scar pregnancy(FER)+uterine cicatricial repair(UCR),group B underwent uterine artery embolization(UAE)+hysteroscopic FER under ultrasonic monitoring,and group C underwent laparoscopic FER+UCR.The intraoperative and postoperative conditions,as well as the incidence of recurrent CSP(RCSP)rate and repregnancy rate during follow-up in the three groups were com-pared.Results:① The intraoperative blood loss,postoperative uterine drainage volume and postoperative VAS score in groups A and B were lower than those in group C,while the operation time and hospitalization cost were higher than those in group C(P＜0.05).The operation time and hospitalization cost in group A were lower than those in group B(P＜0.05).②The postoperative vaginal hemostasis time,menstrual recovery time and recovery time of serum β-human chorionic gonadotropin(β-HCG)in groups A and B were shorter than those in group C(P＜0.05).③There was no statistically significant difference in the incidence of postoperative complications such as adhesion,infection,severe bleeding,and lower abdominal pain among the three groups(P＞0.05).④The mean follow-up time after surgery was(17.60±5.61)months,and the incidence of RCSP in group A and group C was lower than that in group B(P＜0.05).The rate of repregnancy in group A,group B and group C was 82.14％(23/28),77.78％(21/27)and 81.48％(22/27),respectively,and there was no significant difference in the rate of repregnancy among the three groups(P＞0.05).Conclusions:Laparoscopic UAL+FER+UCR and UAE+ultrasound monitoring hysteroscopic FER can reduce intraoperative bleeding and promote postoperative re-covery,but the surgery time is prolonged and hospitalization costs are higher;After using UCR treatment,the inci-dence of RCSP is lower.Clinical evaluation should be based on the specific condition,economic conditions,and need to preserve fertility of type Ⅱ and Ⅲ CSP patients,and personalized treatment plans should be developed.

Objective:To explore the effects of different surgical methods on the treatment outcomes and prog-nosis in patients with caesarean section scar pregnancy(CSP).Methods:A total of 90 patients with type n or ⅢCSP admitted to Department of Obstetrics and Gynecology,Affiliated Hospital of Jinggangshan University be-tween February 1,2021 and February 1,2022 were selected as the study subjects.They were enrolled in order of inclusion,exclusion criteria,and admission treatment time.According to different treatment methods,they were di-vided into group A(30 cases),group B(30 cases)and group C(30 cases).The group A underwent laparoscopic uterine artery ligation(UAL)+focus excision and repair of scar pregnancy(FER)+uterine cicatricial repair(UCR),group B underwent uterine artery embolization(UAE)+hysteroscopic FER under ultrasonic monitoring,and group C underwent laparoscopic FER+UCR.The intraoperative and postoperative conditions,as well as the incidence of recurrent CSP(RCSP)rate and repregnancy rate during follow-up in the three groups were com-pared.Results:① The intraoperative blood loss,postoperative uterine drainage volume and postoperative VAS score in groups A and B were lower than those in group C,while the operation time and hospitalization cost were higher than those in group C(P＜0.05).The operation time and hospitalization cost in group A were lower than those in group B(P＜0.05).②The postoperative vaginal hemostasis time,menstrual recovery time and recovery time of serum β-human chorionic gonadotropin(β-HCG)in groups A and B were shorter than those in group C(P＜0.05).③There was no statistically significant difference in the incidence of postoperative complications such as adhesion,infection,severe bleeding,and lower abdominal pain among the three groups(P＞0.05).④The mean follow-up time after surgery was(17.60±5.61)months,and the incidence of RCSP in group A and group C was lower than that in group B(P＜0.05).The rate of repregnancy in group A,group B and group C was 82.14％(23/28),77.78％(21/27)and 81.48％(22/27),respectively,and there was no significant difference in the rate of repregnancy among the three groups(P＞0.05).Conclusions:Laparoscopic UAL+FER+UCR and UAE+ultrasound monitoring hysteroscopic FER can reduce intraoperative bleeding and promote postoperative re-covery,but the surgery time is prolonged and hospitalization costs are higher;After using UCR treatment,the inci-dence of RCSP is lower.Clinical evaluation should be based on the specific condition,economic conditions,and need to preserve fertility of type Ⅱ and Ⅲ CSP patients,and personalized treatment plans should be developed.

Objective:To explore the effects of different surgical methods on the treatment outcomes and prog-nosis in patients with caesarean section scar pregnancy(CSP).Methods:A total of 90 patients with type n or ⅢCSP admitted to Department of Obstetrics and Gynecology,Affiliated Hospital of Jinggangshan University be-tween February 1,2021 and February 1,2022 were selected as the study subjects.They were enrolled in order of inclusion,exclusion criteria,and admission treatment time.According to different treatment methods,they were di-vided into group A(30 cases),group B(30 cases)and group C(30 cases).The group A underwent laparoscopic uterine artery ligation(UAL)+focus excision and repair of scar pregnancy(FER)+uterine cicatricial repair(UCR),group B underwent uterine artery embolization(UAE)+hysteroscopic FER under ultrasonic monitoring,and group C underwent laparoscopic FER+UCR.The intraoperative and postoperative conditions,as well as the incidence of recurrent CSP(RCSP)rate and repregnancy rate during follow-up in the three groups were com-pared.Results:① The intraoperative blood loss,postoperative uterine drainage volume and postoperative VAS score in groups A and B were lower than those in group C,while the operation time and hospitalization cost were higher than those in group C(P＜0.05).The operation time and hospitalization cost in group A were lower than those in group B(P＜0.05).②The postoperative vaginal hemostasis time,menstrual recovery time and recovery time of serum β-human chorionic gonadotropin(β-HCG)in groups A and B were shorter than those in group C(P＜0.05).③There was no statistically significant difference in the incidence of postoperative complications such as adhesion,infection,severe bleeding,and lower abdominal pain among the three groups(P＞0.05).④The mean follow-up time after surgery was(17.60±5.61)months,and the incidence of RCSP in group A and group C was lower than that in group B(P＜0.05).The rate of repregnancy in group A,group B and group C was 82.14％(23/28),77.78％(21/27)and 81.48％(22/27),respectively,and there was no significant difference in the rate of repregnancy among the three groups(P＞0.05).Conclusions:Laparoscopic UAL+FER+UCR and UAE+ultrasound monitoring hysteroscopic FER can reduce intraoperative bleeding and promote postoperative re-covery,but the surgery time is prolonged and hospitalization costs are higher;After using UCR treatment,the inci-dence of RCSP is lower.Clinical evaluation should be based on the specific condition,economic conditions,and need to preserve fertility of type Ⅱ and Ⅲ CSP patients,and personalized treatment plans should be developed.

BACKGROUND: Management of gastric leak after sleeve gastrectomy (SG) is challenging due to its unpredictable outcomes. We aimed to summarize the characteristics of SG leaks and analyze interventions and corresponding outcomes in a real-world setting. METHODS: To retrospectively review of 15,721 SG procedures from 2010 to 2020 based on a national registry. A cumulative sum analysis was used to identify a fitting curve of gastric leak rate. The Kaplan-Meier method and log-rank tests were performed to calculate and compare the probabilities of relevant outcomes. The logistic regression analysis was conducted to determine the predictors of acute leaks. RESULTS: A total of 78 cases of SG leaks were collected with an incidence of 0.5% (78/15,721) from this registry (6 patients who had the primary SG in non-participating centers). After accumulating 260 cases in a bariatric surgery center, the leak rate decreased to a stably low value of under 1.17%. The significant differences presented in sex, waist circumference, and the proportion of hypoproteinemia and type 2 diabetes at baseline between patients with SG leak and the whole registry population ( P = 0.005, = 0.026, <0.001, and = 0.001, respectively). Moreover, 83.1% (59/71) of the leakage was near the esophagogastric junction region. Leakage healed in 64 (88.9%, 64/72) patients. The median healing time of acute and non-acute leaks was 5.93 months and 8.12 months, respectively. Acute leak (38/72, 52.8%) was the predominant type with a cumulative reoperation rate >50%, whereas the cumulative healing probability in the patients who required surgical treatment was significantly lower than those requring non-surgical treatment ( P = 0.013). Precise dissection in the His angle area was independently associated with a lower acute leak rate, whereas preservation ≥2 cm distance from the His angle area was an independent risk factor. CONCLUSIONS Male sex, elevated waist circumference, hypoproteinaemia, and type 2 diabetes are risk factors of gastric leaks after SG. Optimizing surgical techniques, including precise dissection of His angle area and preservation of smaller gastric fundus, should be suggested to prevent acute leaks.
Humans ; Male ; Retrospective Studies ; Diabetes Mellitus, Type 2/complications* ; Obesity, Morbid ; Anastomotic Leak/epidemiology* ; Gastrectomy/methods* ; Reoperation/methods* ; Registries ; Laparoscopy/methods* ; Treatment Outcome

Objective To compare the effect of postoperative between total intravenous anesthesia(TIVA)use of alfentanil and remifentanil undergoing endoscopic sinus surgery.Methods A total of 130 and thirty patients scheduled for endoscopic sinus surgery,62 males and 68 females,aged 18-64 years,BMI 18-30 kg/m2,ASA physical status Ⅰ or Ⅱ,were randomly divided into two groups:alfentanil group(group A)and remifentanil group(group R).Midazolam 0.02 mg/kg,propofol target-controlled infusion(TCI)3 μg/ml,alfentanil 20 μg/kg,and rocuronium 0.6 mg/kg were injected intravenously in group A,and target-controlled infusion of propofol combined with alfentanil was used to maintain anesthesia.Midazo-lam 0.02 mg/kg,propofol TCI 3 μg/ml,remifentanil 1 μg/kg,and rocuronium 0.6 mg/kg were injected intravenously in group R,and target-controlled infusion of propofol combined with remifentanil was used to maintain anesthesia.The number of intraoperative hemodynamic adverse reactions such as hypertension,tachycardia,hypotension,bradycardia during operation,and pain degree at 30 minutes,60 minutes,24 hours after operation,extubation time,and rescue analgesia and adverse reactions such as nausea and vomi-ting,skin pruritus,respiratory depression within 24 hours after operation were recorded.Results Compared with group R,the incidence of intraoperative hypotension in group A was significantly lower(P＜0.05),the incidence of painless in group A 30 and 60 minutes after operation was significantly higher(P＜0.05),the incidence of mild and moderate pain was significantly decreased(P＜0.05),and the recovery time was significantly prolonged(P＜0.05).There was no significant difference in rescue analgesia within 24 hours after operation.There were no significant differences in the incidence of postoperative nausea and vomiting,postoperative skin pruritus,and respiratory depression between the two groups.Conclusion In endoscopic sinus surgery,the effect of total intravenous anesthesia with alfentanil on postoperative analgesia is better than that of remifentanil,and the incidence of perioperative and postoperative adverse reactions in alfentanil is lower than that of remifentanil,while the recovery time of alfentanil is slightly longer than that of remifentanil.