ABSTRACT
Objective To evaluate the short-term and long-term efficacy of conservative laparoscopic surgery combine with goserelin in treatment of severe ovarian endometriosis.Methods From January 2004 to December 2008,206 patients with severe ovarian endometriosis underwent laparoscopy surgery in Nanjing Drum Tower Hospital,Affiliated Nanjing University Medical School were enrolled in this retrospective study.According to the revised classification American Fertility Society (r-AFS), 123( 123/206,59.7％ ) cases were at stage Ⅲ and 83 ( 83/206,40.3％ ) patients were at stage Ⅳ.Among 138 cases presented pelvic pain.All the patients underwent laparoscopic cystectomy,of which 117 patients with childbearing preserving underwent hysteroscopy and hydrotubation examination,including 7 cases with bilateral salpingectomy,2 cases with bilateral tubal obstruction and 108 cases with normal reproduction.After surgery,all cases were administered by goserelin treatment at dose of 3.6 mg per 28 days for 3 to 6 months.At 1 to 5 years following up,pelvic pain,pregnancy and recurrence were observed,those factors associated with pregnancy rate and endometriosis recurrence were analyzed.Results (1)Pelvic pain:complete remission rate of pelvic pain was 76.1％ ( 105/138 ) at 1 to 5 years after surgery.(2) Pregnancy:total pregnancy rate was 70.4％ (76/108),spontaneous pregnancy rate was 68.8％ (66/96) and pregnant rate of in vitro fertilization and embryo transfer (IVF-ET) was 10/12.Pregnancy rate at 1 year was 57.3％( 55/96 ) and accounting for 83.3％ ( 55/66 ) in all pregnant womon.Live birth rates of spontaneous pregnant and IVF-ET were 86.4％ ( 57/66 ) and 9/10,respectively.( 3 ) Recurrence:the total recurrence rate was 8.3％ ( 17/206 ) at 1 to 5 years.The recurrence rates and the cumulative recurrence rates were 3.9％(8/206) and 3.9％ (8/206) at the first year after operation,2.0％ (3/149)and 6.7％ ( 10/149 )at the second year,1.0％ (1/99) and 8.0％ (8/99) at the third year,10.9％ (5/46)and 17.4％ (8/46) at the fourth year,0 and 2/18 at the fifth year,respectively.Conclusion It was suggested that conservative laparoscopic surgery combined with goserelin in treatment of stage Ⅲ or Ⅳ ovarian endometriosis could reduce the recurrence risk of severe ovarian endometriosis and improve the pregnant rate of endometriosisassociated infertility.
ABSTRACT
Objective To access evaluate the efficacy and safety of on-line hemodiafiltration for treating a-cute cerebrovascular disease (ACVD) patients complicated with hyperosmolar nonketotie diabetic coma (HNDC).Method Totally 11 patients of ACVD complicated with HNDC were observed for this prospective control study.All of them underwent on-line hemodiafiltrafion for 90 minutes using Fressnius 4008S Hemodialysis Machine withONLILNEplus TM and F60 one hour after final diagnosis was made. The bicarbonate ultrafiltrate rate was set at 500ml/min and blood flow at 150 ～ 180 ml/min; and the substitute fluid were infused with post-dilution at 50 ～ 60ml/min. The symptom of brain edema and cardiac insufficiency during the same course of treatment was observed.Blood were taken from the patients to detect serum kalium, serum glucose, serum natrium, BUN and plasma os-motic pressure at one hour before treatment and six hours after treatment, respectively. The change of in conscious-ness and adverse effects were evaluated at 24 hours after treatment. Results All patients were treated successful-ly. The blood glucose, serum natrium, serum kalium, BUN and plasma osmotic pressure were decreased after on-line hemodiafiltration. Among the 11 patients, consciousness was improved obviously in 8 patients, 3 patientsdied, accounting for 73% of successful effectiveness. Conclusions The on-line hemodiafiltration was effectiveand safe for treating ACVD patients complicated with HNDC.
ABSTRACT
Objective To evaluate effects of different laparoscopic procedures for hydrosalpinx on ovarian responses to superovulation induction during in vitro fertilization-embryo transfer(IVF-ET).Methods A total of 65 patients with infertility derived from hydrosalpinx underwent 67 cycles of IVF-ET from January 2002 to January 2005.Before the IVF-ET,the patients were given bilateral laparosocpic salpingectomy(Group A,n=47,48 cycles) or laparosocpic proximal tubal ligation and distal tubal salpingostomy(Group B,n=18,19 cycles).Another 58 patients with proximal tubal occlusion without hydrosalpinx were simultaneously included for 58 cycles of IVF-ET(Group C).Results The fertilization rates,cleavage rates,implantation rates,and clinical pregnancy rates were 85%?21%,95%?17%,49%(55/113),and 79%(38/48) in the Group A,83%?17%,98%?7%,47%(21/45),and 68%(13/19) in the Group B,and 81%?22%,92%?16%,41%(57/140),and 66%(38/58) in the Group C,respectively,without statistically significant difference among the 3 groups(F=0.48,P=0.620;F=1.22,(P=0.297);?~2=1.691,P=0.429;?~2=2.471,P=0.291).The doses of gonadotrophin,the duration of stimulation,and the number of retrieved oocytes were 29.4?10.3 vials,9.4?1.7 d,and 11.4?5.6 in the Group A,24.7?7.7 vials,9.0?1.8 d,and 12.8?6.1 in the Group B,and 28.4?8.8 vials,9.1?1.8 d,and 11.4?5.3 in the Group C,respectively,without statistically significant difference among the 3 groups(F=1.77,P=0.174;F=0.52,P=0.593;F=0.51,P=0.599).Conclusions Laparosocpic salpingectomy or laparosocpic proximal tubal ligation with distal tubal salpingostomy for hydrosalpinx does not impair ovarian responses to the superovulation induction.Both of the procedures may be considered for the treatment of hydrosalpinx prior to IVF-ET.