Clinical outcomes analysis of fertility-preserving therapy for atypical endometrial hyperplasia and early endometrial carcinoma / 中华肿瘤杂志

Objective: To analyze the clinical efficacy of fertility-preserving therapy in patients with atypical endometrial hyperplasia (AEH) and early endometrial carcinoma (EC). Methods: The general condition, pathological type, treatment plan, tumor outcomes and pregnancy outcomes of 110 patients with AEH and EC treated with fertility-preserving therapy in Peking University People's Hospital from December 2005 to September 2019 were retrospectively analyzed. Kaplan-Meier and Log rank tests were used for survival analysis. Results: The response rate of 110 cases of AEH (62 cases) and EC (48 cases) was 94.5% (104/110) after fertility-preserving therapy. There were 93 cases (84.5%) achieved complete response and 11 cases (10.0%) achieved partial response, and the recurrence rate was 29.0% (27/93). The complete response rates of AEH and EC were 90.3% (56/62) and 77.1% (37/48), respectively, without significant difference (P=0.057). The recurrence rates of EC were significantly higher than that of AEH (40.5% vs 21.4%; P=0.022). Forty-one patients with complete response had pregnancy intention, the pregnancy rate was 70.7% (29/41), and the live birth rate was 56.1% (23/41). The live birth rate of AEH was 68.2% (15/22) and that of EC was 42.1% (8/19), the difference was statistically significant (P=0.032). The pathological type was related with the recurrence (P=0.044). Conclusions: Patients with AEH and EC can obtain high complete response rate and pregnancy rate after fertility-preserving therapy. The recurrence rate of EC is higher than that of AEH, while the live birth rate of AEH is higher than that of EC.

Vaginal hysterectomy in non-prolapsed uteruses: 6-year experience / Histerectomia vaginal em útero sem prolapso: experiência de 6 anos

OBJECTIVE: To evaluate the applicability of the technique of vaginal hysterectomy in non-prolapsed uterus. METHODS: A retrospective cohort study with 220 patients submitted to vaginal hysterectomy from January 2004 to July 2010 by the Vaginal Surgery and Pelvic Floor Team. Patients mean age was 44.4 years and they had on average three births (0-10 deliveries). The surgery was performed even in cases of previous abdominal surgery, and cesarean section was prevalent in 54.6% of patients. RESULTS: The mean uterus weight was 278.9g. The mean operative time was 93 minutes, and length of hospital stay was 24 hours after surgery in 65% of cases. There were no cases of visceral injury. The mean postoperative complication was cellulitis of the vaginal vault that occurred in 11 cases (5%) that received antibiotics. Mean blood loss corresponded to 1.4g/dL hemoglobin. From the analyzed sample, vaginal hysterectomy by vaginal route was feasible in 96.8% of patients, and abdominal conversion was necessary in 3.2%. CONCLUSION: Vaginal hysterectomy is a minimally invasive surgery, with fewer complications, and low morbidity. We believe that this procedure should be indicated to treat gynecological benign diseases.

OBJETIVO: Avaliar a aplicabilidade da técnica de histerectomia vaginal em úteros sem prolapso. MÉTODOS: Estudo de coorte retrospectivo de 220 pacientes submetidas à histerectomia vaginal no período de janeiro de 2004 a julho de 2010, pela Equipe de Cirurgia Vaginal e do Assoalho Pélvico. A média de idade dos pacientes foi de 44,4 anos e tiveram, em média, 3 partos (0-10 partos). A cirurgia foi realizada mesmo em casos de cirurgias abdominais prévias; a cesárea foi prevalente em 54,6% da amostra. RESULTADOS: O peso médio do útero foi de 278,9g. O tempo cirúrgico médio foi de 93 minutos, e o tempo de internação foi de 24 horas pós-operatórias em 65% dos casos. Não houve nenhum caso de lesão visceral. A complicação pós-operatória mais frequente foi celulite de cúpula, que ocorreu em 11 casos (5%), sendo tratadas com antibioticoterapia. A perda sanguínea foi, em média, de 1,4g/dL de hemoglobina. Foi possível a realização da histerectomia pela via vaginal em 96,8% das pacientes da amostra estudada e em 3,2% foi necessária a conversão para via abdominal. CONCLUSÃO: A histerectomia vaginal é uma cirurgia por orifício natural, minimamente invasiva, com baixas frequência de complicações e morbidade, sendo factível e segura para o tratamento de afecções uterinas benignas.

Histerectomía laparoscópica tipo IV: Servicio Cirugía II Hospital Universitario de Caracas / Laparoscopic hysterectomy type IV: Servicio Cirugia II Hospital Universitario de Caracas

Evaluar la histerectomía laparoscópica en comparación con las histerectomías abiertas. Estudio prospectivo descriptivo realizado entre los años 2007-2009, con una población de 32 mujeres a las que se les realizó una histerectomía totalmente laparoscópica (tipo IV según la Asociación de Ginecólogos Americanos). Las variables evaluadas fueron edad, índice de masa corporal, cirugías previas, diagnóstico preoperatorio, cirugía asociada, sangrado, tiempo quirúrgico, complicación, hospitalización, dolor medido por la escala analógica del dolor. En el Hospital Universitario de Caracas, Servicio de Cirugía II. La edad promedio de la población fue de 47,7 años y el índice de masa corporal de 25,8 kg/m2, con un tamaño uterino promedio menor a 14 semanas de gestación. El diagnóstico preoperatorio fue de miomatosis uterina en 25 pacientes (78,12 por ciento), en dos casos hubo hiperplasia endometrial (6,25 por ciento), un pólipo endometrial (3,12 por ciento), una paciente con NIC III (3,12 por ciento), 3 casos con histerocele (9,37 por ciento). Hubo cirugía asociada en 5 pacientes. El sangrado fue menor de 50 mL, con un tiempo quirúrgico promedio de 84,6 minutos. No se presentaron complicaciones inherentes a la cirugía y tuvimos un tiempo de hospitalización promedio de 33,39 horas. Escala analógica del dolor promedio 3. La histerectomía laparoscópica tipo IV es una técnica segura con resultados satisfactorios y superior en algunos aspectos en comparación con la histerectomía abierta convencional

To evaluate laparoscopic hysterectomy compared with open hysterectomy. Prospective descriptive study conducted between 2007-2009, with a population of 32 women that underwent total laparoscopic hysterectomy (type IV according to the of American Gynecologists Association). The variables assessed were age, body mass index, previous surgeries, preoperative diagnosis, associated surgery, bleeding, surgical time, complications, hospitalization, pain measured by the visual analog scale of pain. Hospital Universitario de Caracas, Servicio de Cirugi a II. The average age of the population was 47.7 years and body mass index of 25.8 kg/m2, with an average uterine size less than 14 weeks gestation. The preoperative diagnosis was uterine fibroids in 25 patients (78.12 percent), two cases had endometrial hyperplasia (6.25 percent), endometrial polyp (3.12 percent), one patient with CIN III (3.12 percent ), 3 cases with hysterocele (9.37 percent). Surgery was associated in 5 patients. The bleeding was less than 50 mL, with a mean operative time was 84.6 minutes. There were no complications due to surgery and had a mean hospital stay of 33.39 hours. Average pain analog scale 3. Laparoscopic hysterectomy type IV is a safe technique with satisfactory results and in some respects superior compared to conventional open hysterectomy

Clinico-pathological analysis of hysterectomies in various age groups at Hyderabad, Pakistan

To study the frequency and pattern of benign, premalignant, and malignant lesion in hystrectomized uteri and perform clinic-pathological analysis. All hysterectomy specimens received in the histopathology departments of Isra University Hyderabad and Liaquat University of Medical and Health Sciences Hyderabad during the period of January 2005 to December 2006 were studied. A randomized study of 100 cases undergoing hysterectomy was carried out and clinicopathological analysis was done. Most women who underwent hysterectomy were in the age group of 25-75 years. Two proformas were designed to record the clinical information and gross and histopathological findings. Specimens were preserved in 10% formalin and thorough gross examination was done. Representative blocks were processed for paraffin embedding. Abnormal menstrual flow was the most common complaint. Mean age of the patient was 43.06 +/- 7.34 years. Out of 100 cases, endometrial diseases were the most common finding [in67% of the cases] followed by adenomyosis [47%], leiomyoma [32%], cervical intraepithelial neoplastic changes [04%], and invasive cervical carcinoma [03%]. This study concludes that benign uterine lesions are common, consisting mostly of endometrial hyperplasia, leiomyoma, and adenomyosis, and are almost equally present in women above and below the age of 40 years in Hyderabad with the exception of endometrial carcinoma and invasive cervical carcinoma which were commonly found above 40 years of age

Correlación anatomopatológica de las hiperplasias endometriales antes y después de la histerectomía / Histopathological correlation of endometrial hyperplasia: before and after of hysterectomy

Objetivo: Correlacionar histológicamente las biopsias del legrado uterino con las biopsias de las piezas de histerectomía en pacientes con hiperplasia endometrial (HE). Método: Se diagnosticaron con biopsia de legrado uterino 90 pacientes con HE entre enero de 2001 y diciembre de 2005. De estas pacientes, 46 correspondieron a HE con atipia (grupo 1) y 44 a HE sin atipia (grupo 2). Todas las pacientes del grupo 1 se sometieron a histerectomía total más salpingooforectomía bilateral. A 28 pacientes del grupo 2 se les realizó la misma cirugía por patologías ginecológicas asociadas. Se compararon los resultados de las biopsias pre y postoperatorias de las 74 pacientes operadas, evaluándose la concordancia entre ellas. Resultados: En la biopsia de la pieza de histerectomía del grupo 1 se observan 31 casos con HE con atipia (67,4 por ciento), 13 casos (28,3 por ciento) sin atipias y 2 casos (4,3 por ciento) de cáncer endometrial. En el grupo 2 hubo 16 casos (57,1 por ciento) con HE sin atipia, 10 casos (35,7 por ciento) con endometrio normal y 2 (7,1 por ciento) casos de HE con atipia. La concordancia fue de un 63 por ciento (p=0,000) entre ambas biopsias y resultó significativamente más baja en el subgrupo de pacientes que presentaban atipias en la biopsia preoperatorio, respecto a las pacientes sin atipias (p=0,028). El likehood ratio de la biopsia preoperatorio de pacientes con HE con atipias fue de 33,2. Conclusión: El diagnóstico con biopsia preoperatoria por legrado, de las pacientes con HE, tuvo una precisión aceptable en comparación a la biopsia de la pieza operatoria, apoyando su utilidad en el manejo de estas pacientes.

Objective: To evaluate the hystopathologic correlation between curettage and hysterectomy specimens in patients with endometrial hyperplasia. Methods: 90 patients were diagnosed with endometrial hyperplasia in curettage specimens between January 2001 and December 2005. Of these patients 46 were found to have atypical hyperplasia (group 1) and 44 hyperplasia without atypias (group 2). All the patients in group 1 had a total hysterectomy plus bilateral anexectomy; 28 patients of group 2 had the same surgery because of associate gynecological pathology. Curettage and hysterectomy specimens of 74 patients were compared and evaluated the concordance between them. Results: Of hysterectomy specimens in group 1, 31 cases had atypical hyperplasia (67.4 percent), 13 cases (28.3 percent) hyperplasia without atypias and 2 cases (4.3 percent) with endometrial carcinoma. In group 2, 16 cases (57.1 percent) of hyperplasia without atypias, 10 cases (35.7 percent) with normal endometrium and 2 (7.1 percent) cases of atypical hyperplasia were found. The agreement of the hysto-pathological diagnosis of endometrial hyperplasia between both biopsies was 63 percent (p=0.000) and it was significantly lower in the subgroup of patients that had atypias on the curettage biopsy with respect to the patients with hyperplasia with no atypias (p=0.028). The likehood ratio of the biopsy by curettage of patients with atypias was of 33.2. Conclusion: The accuracy of the curettage biopsies as compared with hysterectomy specimens in patients with endometrial hyperplasia was acceptable, supporting its usefulness in the management of these patients.

Histeroscopía quirúrgica: análisis de la experiencia en cirugía uterina endoscópica ambulatoria de 100 pacientes / Surgical hysteroscopy: experience in ambulatory endoscopic uterine surgery in 100 patients

Se analizan 103 histeroscopias quirúrgicas ambulatorias realizadas en un centro de atención ambulatoria. Las pacientes tenían entre 21 y 81 años de edad; el motivo de consulta principal fue el sangrado uterino anormal en un 34 por ciento, y alteracion del examen ecográfico de la cavidad uterina en un 65 por ciento. A todas las pacientes se les realizó resección endoscópica o biopsia amplia con visión directa de la cavidad uterina, usando medio de distensión líquida, con estudio anatomopatológico diferido de todas las muestras. Los principales diagnóstico histológicos fueron pólipos, mioma, e hiperplasia endometrial. Destaca el hallazgo de 2 casos de cáncer endometrio. Todas las pacientes se controlaron a los 7 y 30 días posterior al procedimiento, no existiendo complicaciones mayores en ninguna de ellas. Se plantea la necesidad de adiestramiento y difusión de esta técnica. Así como queda planteada la posibilidad de su realización ambulatoria

Experiencia preliminar en histeroscopia quirúrgica ambulatoria / Preliminar experience in ambulatory surgical histeroscopy

Se analizan las primeras 20 histeroscopias quirúrgicas realizadas en un centro de atención ambulatoria. corresponden a 20 pacientes entre 30 y 81 años de edad, con distinta paridad (0 a 8 partos). La duración promedio del procedimiento fue 30 minutos. En 19 de las pacientes el diagnóstico previo establecido por estudio histeroscópico fue tumor endometrial, y en un caso de engrosamiento endometrial. A todas las pacientes se les realizó resección endoscópica, con estudio histopatológico del material extraido. No se presentaron complicaciones atribuibles al procedimiento, se las controló a los 7 y 30 días posteriores. Se plantea la necesidad de adiestramiento, difusión y práctica de esta técnica endoscópica

Histerectomias abdominais: análise de 1766 cirurgias / Abdominal hysterectomies: analysis of 1766 cases

Os autores analisaram 1766 histerectomias abdominais realizadas na Clínica Ginecológica do Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina da U.F.M.G, no período de 1940 a 1987. A miomatose uterina foi a principal indicaçao da cirurgia, a qual ocorreu com maior freqüência em mulheres na faixa etária entre 40 e 49 anos e nas nulíparas. As complicaçoes no pós-operatório imediato ocorreram em 3,2 por cento das histerectomias realizadas, destacando-se a infecçao da cicatriz cirúrgica.

Histerectomia vaginal em pacientes näo portadoras de prolapso do útero: estudo de 370 casos / Vaginal histerectomy in patients without uterine prolapse: study of 370 cases

O presente trabalho consta de um estudo prospectivo de 370 histerectomias vaginais realizadas em pacientes nao portadoras de prolapso uterino. Os diagnósticos mais freqüentes foram: mioma uterino (30,3 por cento), hiperplasia de endométrio (27,8 por cento), hemorragia uterina disfuncional(l6,5 por cento) e displasia do colo do útero (22,7 por cento). O maior número de cirurgias incidiu em pacientes de faixa etária compreendida entre 40 e 49 anos (66,5 por cento). Em 96,7 por cento dos casos, nao houve complicaçoes decorrentes do procedimento cirúrgico, sendo o tempo médio de internaçao 72 horas e a duraçao média da intervençao de 60 minutos. Pela análise dos resultados, concluiu-se que a via vaginal é uma opçao favorável para a remoçao do útero, redundando em ato operatório simples, pouco traumático, que propiciou recuperaçao rápida das pacientes.