The Effect of Perioperative Comprehensive Nursing on Patients Undergoing Ovary Endometriosis Laparoscopic Surgery.

Objective: To assess the effectiveness of perioperative nursing interventions in improving outcomes and satisfaction for patients undergoing laparoscopic surgery for ovarian endometriosis. Methods: From July 2021 to September 2022, 80 patients with endometriosis underwent laparoscopic surgery at Shijiazhuang Fourth Hospital and were randomly assigned to the conventional (n=40) and experimental (n=40) groups. During the perioperative period, patients in the conventional group received standard nursing interventions, while patients in the experimental group received comprehensive nursing interventions. The two groups were compared in terms of postoperative clinical indicators, self-rated anxiety scale (SAS) and self-rated depression scale (SDS) scores, nursing compliance, complications, and nursing satisfaction. Results: comprehensive nursing resulted in better postoperative clinical indices (time to get out of bed, hospital stay) versus routine nursing (all P < .001). The comprehensive nursing led to significantly lower SAS and SDS scores versus routine nursing. The nursing compliance of the patients in the experimental group was significantly higher than that of the patients in the conventional group (P < .001). Comprehensive nursing was associated with a significantly lower incidence of complications versus routine nursing (P < .001). Comprehensive nursing contributed to significantly higher nursing satisfaction versus routine nursing (P < .001). Conclusion: Comprehensive perioperative nursing interventions for patients with ovarian endometriosis undergoing laparoscopic surgery considerably accelerate patient recovery and enhance nursing compliance, as well as minimize patient negative emotions and improve patient satisfaction with nursing.  The comprehensive approach addresses the specific needs of patients during the recovery period, minimizing postoperative complications, accelerating patient recovery, and improving overall quality of life. By integrating psychological support, tailored strategies for pain management, early mobilization, and prompt intervention for complications, this intervention sets a benchmark for holistic care in gynecological surgery.

Reproductive outcomes of ectopic pregnancy with conservative and surgical treatment: A systematic review and meta-analysis.

BACKGROUND: Ectopic pregnancy (EP), one of the most common gynecological emergencies, is the major cause of maternal death in the first trimester and increases the incidence of infertility and repeat ectopic pregnancy (REP). The aim of this study was to compare the effects of different treatment methods for tubal EP on natural pregnancy outcomes. METHODS: We systematically searched PubMed, Embase, Cochrane Library, Web of Science, and Clinical Trials for observational studies on EP (published until October 30,2022 in English) comparing methotrexate (MTX) versus surgery, MTX versus salpingostomy, MTX versus salpingectomy, salpingostomy versus salpingectomy, and MTX versus expectant treatment. Our main endpoints included subsequent natural intrauterine pregnancy (IUP) and REP. We assessed the pooled data using Review Manager software (version 5.3) with a random effects model. RESULTS: Of 1274 identified articles, 20 were eligible and 3530 participants were included in our analysis. There was a significant difference in the odds of subsequent IUP in tubal EP patients who underwent MTX compared with those who were treated with surgery [odds ratios (OR) = 1.52, 95% confidence interval (CI):1.20-1.92]. No significant difference was found in the odds of REP between the 2 groups (OR = 1.12, 95% confidence interval [CI]: 0.84-1.51). There was no significant difference in the odds of subsequent IUP and REP in patients after MTX compared to those after salpingostomy (OR = 1.04,95% CI: 0.79-1.38; OR = 1.10, 95% CI: 0.64-1.90). There was a significant difference in the odds of subsequent IUP in patients after MTX compared with those after salpingectomy (OR = 2.11, 95% CI: 1.52-2.93). No significant difference was found in the odds of REP between the 2 groups (OR = 0.98, 95% CI: 0.57-1.71). There was a significant difference in the odds of subsequent IUP between patients who underwent salpingostomy and those who underwent salpingectomy (OR = 1.61, 95% CI: 1.29-2.01). No significant difference was found in the odds of REP between the 2 groups (OR = 1.21, 95% CI: 0.62-2.37). There was no significant difference in the odds of subsequent IUP and REP in patients after MTX compared with those after expectant treatment (OR = 1.25, 95% CI: 0.64-2.45; OR = 0.69, 95% CI: 0.09-5.55). CONCLUSION: For hemodynamically stable tubal EP patients, MTX has advantages over surgery, particularly salpingectomy, in improving natural pregnancy outcomes. However, MTX is not inferior to salpingostomy and expectant treatment.

Soft tissue release combined with joint-sparing osteotomy for treatment of cavovarus foot deformity in older children: Analysis of 21 cases.

BACKGROUND: Cavovarus foot is a common form of foot deformity in children, which is clinically characterized by an abnormal increase of the longitudinal arch of the foot, and it can be simultaneously complicated with forefoot pronation and varus, rearfoot varus, Achilles tendon contracture, or cock-up toe deformity. Muscle force imbalance is the primary cause of such deformity. Many diseases can lead to muscle force imbalance, such as tethered cord syndrome, cerebral palsy, Charcot-Marie-Tooth disease, and trauma. At present, many surgical treatments are available for cavovarus foot. For older children, priority should be given to midfoot osteotomy and fusion. Since complications such as abnormal foot length, foot stiffness, and abnormal gait tend to develop postoperatively, it is important to preserve the joints and correct the deformity as much as possible. Adequate soft tissue release and muscle balance are the keys to correcting the deformity and avoiding its postoperative recurrence. AIM: To assess the efficacy of soft tissue release combined with joint-sparing osteotomy in the treatment of cavovarus foot deformity in older children. METHODS: The clinical data of 21 older children with cavovarus foot deformity (28 feet) who were treated surgically at the Ninth Department of Orthopedics of Jizhong Energy Xingtai Mining Group General Hospital from November 2014 to July 2017 were retrospectively analyzed. The patients ranged in age from 10 to 14 years old, with an average age of 12.46 ± 1.20 years. Their main clinical manifestations were deformity, pain, and gait abnormality. The patients underwent magnetic resonance imaging of the lumbar spine, electromyographic examination, weight-bearing anteroposterior and lateral X-rays of the feet, and the Coleman block test. Surgical procedures including metatarsal fascia release, Achilles tendon or medial gastrocnemius lengthening, "V"-shaped osteotomy on the dorsal side of the metatarsal base, opening medial cuneiform wedge osteotomy, closing cuboid osteotomy, anterior transfer of the posterior tibial tendon, peroneus longus-to-brevis transfer, and calcaneal sliding osteotomy to correct hindfoot varus deformity were performed. After surgery, long leg plaster casts were applied, the plaster casts were removed 6 wk later, Kirschner wires were removed, and functional exercise was initiated. The patients began weight-bearing walk 3 mo after surgery. Therapeutic effects were evaluated using the Wicart grading system, and Meary's angles and Hibbs' angles were measured based on X-ray images obtained preoperatively and at last follow-up to assess their changes. RESULTS: The patients were followed for 6 to 32 mo, with an average follow-up period of 17.68 ± 6.290 mo. Bone healing at the osteotomy site was achieved at 3 mo in all cases. According to the Wicart grading system, very good results were achieved in 18 feet, good in 7, and fair in 3, with a very good/good rate of 89.3%. At last follow-up, mean Meary's angle was 6.36° ± 1.810°, and mean Hibbs' angle was 160.21° ± 4.167°, both of which were significantly improved compared with preoperative values (24.11° ± 2.948° and 135.86° ± 5.345°, respectively; P < 0.001 for both). No complications such as infection, skin necrosis, or bone nonunion occurred. CONCLUSION: Soft tissue release combined with joint-sparing osteotomy has appreciated efficacy in the treatment of cavovarus foot deformity in older children.