[Comparison of surgery for staging using laparoscopy and laparotomy in patients with endometrial cancer].

OBJECTIVE: To compare the surgical outcomes for staging by laparoscopy and laparotomy in patients with endometrial cancer, evaluate the feasibility of laparoscopic surgical treatment of endometrial cancer, compare the difference between clinical and surgical staging of endometrial cancer and elucidate the advantages and feasibility of its surgical staging. METHODS: Fifty-six patients diagnosed pre-operatively as stage I endometrial cancer were reviewed for surgery for staging. They were assigned into laparoscopic group (n = 34) and laparotomic (open) group (n = 22). The operative parameters including operating time, intra-operative blood loss, the number of lymph nodes removed, gastrointestinal recovery time, urinary catheterization time, complications and post-operative hospital stay were compared. RESULTS: The pre-operative clinical characteristics before operation between two groups were similar. No significant differences were found in age and body mass index between two groups. As compared with the open group, the laparoscopic group had a longer operation time (213 min ± 49 min vs 162 min ± 30 min, P < 0.05), less hemoglobin change (12 g/L ± 8 g/L vs 19 g/L ± 8 g/L, P < 0.05), shorter hospital stay (6.3 d ± 1.7 d vs 9.5 d ± 1.8 d, P < 0.01) and shorter gastrointestinal recovery time (1.8 d ± 0.6 d vs 2.7 d ± 1.2 d, P < 0.01). While there was no significant difference between two groups in the number of lymph nodes removed, urinary catheterization time, costs and complications. The total coincidence was 57.14% between clinical and surgical staging. CONCLUSION: Laparoscopic staging surgery is both feasible and safe in the treatment of endometrial cancer. And the surgical staging truly reflects the extent of cancer invasion and it is thus necessary for early-stage endometrial cancer.

[Perioperative intervention to prevent lower extremity deep venous thrombosis after gynecologic surgery].

OBJECTIVE: To investigate the preventative effect of perioperative intervention to lower extremity deep venous thrombosis (DVT) after gynecologic surgery. METHODS: The 1062 patients,who received gynecologic surgery during 2007 June to 2008 June, were divided into intervention and nonintervention groups randomizely. According to the risk factors of DVT, the patients in intervention group were divided into 4 subgroups: low, mid, high and extremely high risk. Each group had its own preventive measures. If patients had spontaneous pain, tenderness and swelling, positivity of Neuhof or Homan syndrome, and extension of one low extremity superficial vein, the low extremity color Doppler ultrasound would be carried out immediately. The ultrasound would also be routinely carried out in the high and extremely high risk groups in intervention group after 2 and 7 days after surgery. A prospective study was carried out investigating incidence of DVT and coagulation function perioperation. The vein blood samples were taken at in a week before surgery and 48 hours post-operation. RESULTS: The incidence of DVT of intervention group was 1.10% (6/546), and in nonintervention group, the incidence was 3.29% (17/516). There was significant difference between two groups (P < 0.05). The incidence of DVT in extremely high risk subgroup was 21.05% (4/19), which was significantly higher than that of low(0), mid(0)and high risk groups [2.13% (2/94), P < 0.05]. D-dimer, antithrombin-III (AT-III) post-operation were all higher than that pre-operation in the two groups, but there was no significant difference (P > 0.05). The indexes of coagulation system,such as blood platelet count, prothrombin time (PT), active partial thromboplastin time (APTT), fibrinogen (Fbg), thrombin time (TT), tissue-plasminogen activator (t-PA), plasminogen activator inhibitor (PAI), were not significantly changed perioperation (P > 0.05 in all pre-or post-operation indexes). CONCLUSIONS: Perioperative intervention measurement according to different risk of DVT could cut down the incidence of DVT. DVT preventive intervention is suggested to high and extremely high risk people.

[Assessment of different homeostatic methods used in laparoscopic intramural myomectomy].

OBJECTIVE: To explore the safe and effective method of hemostasis in laparoscopic hysteromyomectomy (LM). METHODS: Two hundred and eighty women with symptomatic uterine intramural fibroids undergoing LM were assigned to 4 groups, Group A undergoing fibroid pedicle ligation, Group B injected with 12 IU diluted vasopressin around the myoma, Group C injected with 20 IU oxytocin combined with pedicle ligation, and Group D injected with vasopressin combined with pedicle ligation. The operation time, amount of blood loss, operative complications, bowel deflation, post-operative hemoglobin dropping, and length of hospital stay were compared. RESULTS: The amounts of blood loss of Groups A and C were (171 +/- 146) ml and (184 +/- 140) ml, both significantly higher than those of Groups B and D [(115 +/- 70) ml and (106 +/- 73) ml, both P < 0.01]. The length of hospital stay of Group D was (2.9 +/- 0.5) d, significantly shorter than those of Groups A, B, and C [(3.1 +/- 0.7) d, (3.6 +/- 0.8) d, and (3.3 +/- 0.7) d, all P < 0.05]. The bowel deflation time of Group D was (20 +/- 6) h, significantly shorter than those of the Groups A, B, and C [(26 +/-) h, (25 +/- 7) h, and (25 +/- 8) h respectively, all P < 0.05]. The post-operative hemoglobin dropping of group D was (1.1 +/- 0.9) g/L, significantly less than those of Groups A, B, and C [(1.5 +/- 1.0), (1.4 +/- 0.8), and (1.2 +/- 0.7) g/L respectively, all P < 0.05]. CONCLUSIONS: Vasopressin (12 IU) injection around the myoma is a simple, effective, and safe homeostatic procedure during LM. Pedicle ligation can reduce advanced post-operative bleeding post-operation.

[Analysis of therapeutic result and prognostic factor in primary fallopian tube carcinoma].

OBJECTIVE: To investigate the impact of treatment modality and clinicopathologic profile on prognosis in primary fallopian tube carcinoma. METHODS: The data of 64 cases with primary fallopian tube carcinoma treated between January 1991 and June 2006 were analyzed. The clinicopathological data were retrospectively analyzed. RESULTS: The overall 5-year survival rate of this series was 56.3%. The overall 3- and 5-year survival rate was 84.6% and 65.4% in surgical staging group versus 58.3% and 33.3% in no surgical staging group with a significant difference between two groups (P = 0.0429; P = 0.043), which was 89.5% and 68.4% in optimal cytoreduction group versus 66.7% and 41.7% in suboptimal cytoreduction group (P = 0.0466; P = 0.0444). However, there was no significant difference in 3-year and 5-year survival rate between the group with pelvic lymphadenectomy and the group without (84.2% vs. 69.2%, P = 0.4667; 63.1% vs. 53.8%, P = 0.459), and also between the group treated using CAP/CP regimen and the group by TP regimen for chemotherapy (81.8% vs. 80.0%, P = 0.8946; 59.1% vs. 60.0% P = 0.9582). It was found that the 5-year survival was correlated with FIGO stage (III-IV vs. I - II, P = 0.0197), differentiation grade (G3 vs. G1 + G2, P = 0.003), pathologic type (other type vs. serous, P = 0.0494), lymph nodes status (positive vs. negative, P = 0.0295). CONCLUSION: Surgical staging, optimal cytoreduction, differentiation grade, pathologic type, lymph node status are important factors influencing the 5-year survival in primary fallopian tube carcinoma. Pelvic lymphadenectomy is necessary and feasible to perform during the procedure of surgical staging and cytoreduction. CAP/CP and TP regiment are similarly effective in adjuvant chemotherapy for primary fallopian tube carcinoma.

[Clinical study on different operation procedure for hysterectomy].

OBJECTIVE: To investigate the effects and outcomes of four procedures for hysterectomy. METHOD: Retrospectively, we analyzed the clinical characteristics of 756 cases who respectively received hysterectomy by total abdominohysterectomy (TAH, 260 cases), modified abdominohysterectomy (MAH, 180 cases), transvaginal hysterectomy (TVH, 106 cases), or laparoscopic assisted vaginal hysterectomy (LAVH) (210 cases) and compared their effects and outcomes. RESULTS: The average operation time of TAH (98 +/- 23) minutes, MAH (67 +/- 18) minutes, TVH (63 +/- 19) minutes and LAVH (99 +/- 35) minutes. The average operation time of LAVH and TAH groups was significantly longer than that of TVH and MAH groups (P < 0.05). The volume of hemorrhage during operation in TAH group (180 +/- 49) ml was much more than that of other three groups significantly [MAH (102 +/- 43) ml, TVH (93 +/- 31) ml, LAVH (111 +/- 39) ml]. The average time of antibiotic administration and bowel function recovery in TAH group [(5.2 +/- 2.6) days, (36 +/- 9) hours] was significantly longer than that of TVH [(3.2 +/- 1.6) days, (21 +/- 4) hours], LAVH [(3.5 +/- 1.9) days, (23 +/- 6) hours] and MAH [(3.3 +/- 1.7) days, (23 +/- 7) hours] (P < 0.05). The incidence of fever in TAH group was significantly higher than that of other three groups also. The average hospital stay after operation in TVH [(3.3 +/- 1.2) days] and LAVH [(3.6 +/- 1.1) days] groups was significantly shorter than that of MAH [(5.6 +/- 1.9) days] or TAH [(5.4 +/- 2.3) days] groups (P < 0.05). CONCLUSIONS: Different procedures for total hysterectomy have their own advantages and disadvantages. Microinvasive surgery by laparoscopy for hysterectomy will be mainstream in the future.

Efficacy and safety of lamivudine treatment for chronic hepatitis B in pregnancy.

AIM: To evaluate the efficacy and safety of lamivudine treatment of chronic hepatitis B disease in pregnancy. METHODS: The study group was comprised of 38 chronic HBV patients who were diagnosed pregnant during lamivudine treatment and voluntary to continue the same therapy. The control group was from documented patient data in the literatures. We compared the following parameters with those of a control group: anti-HBV efficacy, complications of pregnancy (abortion, preterm birth, neonatal asphyxia, fetal death, and congenital anomaly), incidence of HBV-positive babies and developmental anomalies in pregnant women treated with lamivudine. RESULTS: The blocking rate of lamivudine treatment was significantly higher than that of active vaccine immunization for babies with double-positive (HBsAg/HBeAg) mothers with 30-30-10 mug doses of vaccine (74.07%) and with 30-20-10 mug (64.87%). The natural vertical HBV transmission from mother to infant of "double-positive" mothers was 100% (10/10). No pregnancy complication was noted during the observation period, but in the control group the incidences of pregnancy complication were 16.67% (abortion), 43.02%(preterm), 15.62% (neonatal asphyxia), and 4.49% (fetal death), 10.0% (congenital anomaly). No HBV-positive newborn was detected and no developmental anomaly was found in the study group. CONCLUSION: Lamivudine is helpful to prevent maternal-infant HBV transmission and may reduce the complications of HBV-infected pregnant patients.

[Clinical study on combined multi-disciplinary laparoscopic surgery].

OBJECTIVE: To investigate the clinic characteristics and efficacy of combined multi-disciplinary laparoscopic surgery. METHODS: Combined laparoscopic surgery was performed in 46 gynecological patients who concomitantly had gastrointestinal and urinary tract diseases as study group, and single gynecologic laparoscopic surgery in 40 patients as control group. The complications and mean time of operations, bowel function restoration, and hospitalization length were observed. RESULTS: The surgery of every patient was successful. None of the cases was transferred to open laparotomy. No complications occurred. The mean time of operations was significantly increased in study group (127 +/- 91) min compared with control group (100 +/- 80) min (P < 0.05). The recovery time of bowel function, as well as the mean time of hospitalization was not different between study group (20 +/- 10) h, (3.7 +/- 1.5) d and control group (19 +/- 10) h, (3.5 +/- 1.3) d (both P > 0.05). CONCLUSIONS: Combined multi-disciplinary laparoscopic surgery can be performed safely and effectively for gynecological patients complicated with gastrointestinal or urinary tract diseases.