Transumbilical Single-port Total Laparoscopic Hysterectomy by Conventional Instruments Without Uterine-lifting / 中国微创外科杂志

Objective To investigate the application value of transumbilical single-port total laparoscopic hysterectomy by conventional instrument without uterine-lifting in the treatment of cervical lesions.Methods We selected 60 cases of total laparoscopic hysterectomy due to cervical high-grade squamous intraepithelial lesion(HSIL)or cervical cancer stage ⅠA1 from December 2021 to June 2023.According to the patients'preference,30 cases of single-port laparoscopy through the umbilicus and 30 cases of multi-port laparoscopy were performed,both using conventional instruments without uterine-lifting.The surgical indicators of the two groups were compared.Results No conversion to open surgery occurred in both groups,and no intraoperative injuries to the urinary system,bowel,or major blood vessels occurred.As compared with the multi-port group,the single-port group had significantly reduced amount of bleeding during surgery[(54.6±20.5)ml vs.(67.5±27.0)ml,P = 0.041],earlier anal exhaust time[(27.6±8.0)h vs.(32.2±9.0)h,P =0.040],and shorter total hospitalization time[(4.4±1.5)d vs.(5.1±1.2)d,P = 0.044].There were no significant differences in uterine weight,surgical time,and postoperative complications between the two group(P>0.05).The healing of the abdominal wall puncture wounds in both groups of patients were satisfied.There were no short-term complications related to the puncture device(such as puncture wound infection and bleeding)or long-term complications(such as umbilical hernia and incisional hernia).Conclusion Transumbilical single-port total laparoscopic hysterectomy without uterine-lifting presents advantages of less intraoperative bleeding,faster postoperative recovery,and almost no scarring,with complications similar to traditional laparoscopic surgery.

Effect of esketamine on analgesic effect and quality of awakening in patients / 中华内分泌外科杂志

Objective:To investigate the analgesic effect and quality of awakening of esketamine in patients undergoing laparoscopic total hysterectomy.Methods:100 patients who underwent laparoscopic total hysterectomy in our hospital from Mar. 2021 to Mar. 2023 were selected and randomly divided into the observation group ( n=50) and the control group ( n=50) . The observation group were injected esketamine during the operation, and the control group were injected an equal amount of saline. Anesthesia induction, maintenance and postoperative analgesic medication were kept the same in both groups. The hemodynamic indexes of heart rate (HR) and mean arterial pressure (MAP) of the two groups were monitored at the moment of entering the room (T0) , the moment of saline/exketamine infusion (T1) , the moment of surgical skin incision (T2) , the moment of skin suture (T3) , the moment of tracheal extubation (T4) , and the moment of exiting the operating room (T5) ; The recovery time of spontaneous respiration, the time of awakening and the time of extubation were counted, and the quality score (steward score) of the awakening was calculated. Exercise and resting visual analog scores (VAS scores) at 2 h, 4 h, 6 h and 8 h after surgery for the two groups of patients were recorded; The number of cases using rescue analgesics after surgery, and the number of times using patient’s self-control intravenous analgesia (PCIA) pumps were counted; The number of patients who experienced adverse reactions (nausea and vomiting, respiratory depression, bradycardia, chills, drowsiness) after surgery were recorded and the incidence rate was calculated. The number of patients was counted and the incidence rate was calculated. Results:The differences in the hemodynamic indexes HR and MAP between the two groups at T0, T1, T2 and T3 were not statistically significant (both P>0.05) . Compared with the control group, the observation group had a significant decrease in the hemodynamic indexes HR at T4 and T5 (101.87 times/min vs 91.67 times/min) (91.53 times/min vs 83.13 times/min) (both P<0.05) . There was no statistically significant difference in the exercise and resting VAS scores between the two groups at 2 h postoperatively (both P>0.05) . Compared with the control group, MAP was significantly reduced in the observation group at T4 and T5 (102.43 mmHg vs 90.4 mmHg) (94.13 mmHg vs 85.53 mmHg) (both P<0.05) . The difference in the exercise and resting VAS scores between the two groups was not statistically significant at 2 h postoperatively (both P>0.05) ; The exercise VAS scores of the patients in the control group at 4 h, 6 h, and 8 h postoperatively were 3.50, 4.70, and 4.63, respectively, and the resting VAS scores of the patients in the control group were 3.43, 4.20, and 4.40; The exercise VAS scores of the patients in the observation group were 2.53, 3.70, and 4.30; The resting VAS scores of patients in the observation group were 2.10, 2.47 (both P<0.05) . In the control group, the number of cases of postoperative rescue analgesic use and the number of patients’ postoperative analgesic pump presses were 2.01±0.73 and 5.87±1.25, respectively; In the observation group, the number of cases of postoperative rescue analgesic use and the number of patients using PCIA pump were 0.43±0.41 and 1.88±0.68, respectively; The number of postoperative rescue analgesic use and the number of patients using PCIA pump were 0.43±0.41 and 1.88±0.68, respectively (both P<0.05) . In the control group, the postoperative recovery time of spontaneous breathing, awakening time and extubation time were 5.67min, 18.77min and 7.40min respectively, while the postoperative spontaneous breathing recovery time, awakening time and extubation time of patients in the observation group were 4.70min, 13.33min and 4.18min, respectively (both P<0.05) . The steward score of the control group was 4.33, and the steward score of the observation group was 5.42 ( P<0.05) . There was no statistically significant difference in the number and incidence of postoperative nausea and vomiting, respiratory depression, bradycardia, chills, or somnolence between the two groups (both P>0.05) . Conclusion:Escitalopram can make the hemodynamics of laparoscopic total hysterectomy patients smooth, reduce postoperative pain, improve the quality of awakening, and reduce adverse reactions.

Establishment of a risk model of placental accreta spectrum by ultrasound combined with clinical high risk factors / 中华超声影像学杂志

Objective:To establish a risk model of placenta accreta spectrum(PAS) based on the clinical risk factors and ultrasound signs of patients with placenta accreta, and identify severe placenta accreta prenatal.Methods:A retrospective analysis was performed on 121 PAS patients admitted to Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University from January 2018 to June 2022 who were clinically classified or pathologically diagnosed during delivery. The two groups were divided into light and severe groups according to the implantation type. The clinical risk factors and ultrasound signs between the two groups were compared. A risk model of PAS was established based on the clinical risk factors and ultrasound signs to predict the perinatal complications.Results:A total of 130 cases of PAS were clinically diagnosed or pathologically diagnosed with placenta, 9 cases with incomplete clinical data or irregular ultrasound images were excluded, and the remaining 121 cases were included in the study. Among the 121 patients, 64 cases were placental accreta, 39 cases were placental increta, and 18 cases were placenta percreta. The placental accreta was defined as mild group, and the combination of placental increta and placenta percreta were referred to as severe group. There were no significant differences in placenta previa, and the number of uterine cavity operations (all P>0.05). There were significant differences in the number of cesarean section, myometrium thinning, placental lacunae, abnormal vascularization at the utero-bladder junction, bridging vessels at the utero-bladder junction, placental protuberance and cervical involvement (all P<0.05). Binary logistic regression analysis showed that placental lacunae, abnormal vasculization of the utero-bladder interface and the number of cesarean sections were independent risk factors for severe PAS. Based on this, a risk model was established and the ROC curve of each independent risk factor and risk model was plotted respectively. The AUC of the risk model was 0.826, which had better diagnostic efficacy than other independent risk factors. Conclusions:In the prenatal ultrasound classification diagnosis of high-risk patients with PAS, the placental lacunae, abnormal vascularization of utero-bladder interface and the number of cesarean section are combined to establish the risk model of PAS, which has a good diagnostic efficacy for severe placenta accreta.

Predictive value of ultrasound signs of the involvement of the cervix in the adverse pregnancy outcomes of placenta accreta spectrum / 中华超声影像学杂志

Objective:To explore the the predictive value of ultrasound signs of the involvement of the cervix in the clinical grade diagnosis of placenta accreta spectrum(PAS) with placenta previa and adverse pregnancy outcomes.Methods:A retrospective analysis was performed on PAS patients with placenta previa diagnosed during delivery or by cesarean section in Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University from January 2018 to March 2021. According to the signs of cervical involvement on prenatal ultrasound, the patients were divided into cervical involvement group and cervical non-involvement group. Logistic analysis was performed on clinical data between the two groups. The clinical data, hysterectomy rate, intraoperative blood loss and clinical diagnosis were compared between the two groups.Results:There were 1 455 patients with PAS diagnosed by clinical diagnosis or placental pathology, of which 170 were with placenta previa, 24 with incomplete clinical data or non-standard ultrasound images, and the remaining 146 patients were included. In the cervical involvement group, all of 6 cases had placenta percreta. Of the 140 cases in the unaffected cervical group, 89 cases (63.6%) had placental accreta, 48 cases (34.3%) had placental increta, and 3 cases (2.1%) had placenta percreta. There were no significant differences of the age and uterine operation history between the two groups. There was significant difference in the number of cesarean sections between the two groups ( P<0.05). There were significant differences in intraoperative blood loss, hysterectomy rate and placenta accreta grade diagnosis between the two groups(χ 2/ Z=4.203, 11.165, 95.248, all P<0.05). Conclusions:The ultrasonographic signs of cervical involvement have a good predictive value for the pregnancy outcome of PAS.

Perioperative blood transfusionfor patients undergoing totalhysterectomy / 中国输血杂志

【Objective】 To analyze the related factors affecting perioperative blood transfusionin patients undergoing totalhysterectomy, explorethe effective measures to reduce allogeneic blood transfusion and provide data for the establishment of clinical blood transfusion single-disease evaluation index of total hysterectomy. 【Methods】 747 cases of total hysterectomy from three grade-A tertiary general hospitals and onematernal and child health care hospitalin Dalian wereselected, and divided into transfusion group(n=69)and non-transfusion(n=678). Detailed information was collected and analyzed, including patient demographics, operation information, blood routine before operation, postoperative recovery and transfusion volume. 【Results】 9.2%(69/747)of total hysterectomy patients received blood transfusion, with per capita red blood usageof(0.4±2.1)U. The age, operative time, volume of intra-operationbleeding, pre-operationhemoglobin(Hb) level, length ofhospital stay, types and days of antibiotics use between transfusion group and non-transfusion groupwere (49.7±9.1)vs(53±9.5)years old, (182.7±83.5)vs(119.5±64.8)min, (603±650)vs(160±173)mL, (96±26)vs(124±18)g/L, (9.3±4.8)vs(7.3±3.9)days, (2.2±1.1)vs(1.6±0.7)kinds, (6.0±3.9)vs (4.4±2.2)days, respectively, showing significant differences(P<0.05). Transfusion volumewas associated with volume of intra-operation bleeding (r=0.004), operative time (r=0.002) and Hb level of pre-operation(r=-0.022). 【Conclusion】 Blood management of patients undergoingtotal hysterectomy should be strengthened to reduce the incidence of allogeneic blood transfusion and improve patient outcomes by raising the pre-operation Hb level, shortening the operative time and reducing the volume of intra-operation bleeding.

A case of small cell neuroendocrine carcinoma of ovary / 中国综合临床

Objective@#Small cell neuroendocrine carcinoma of the ovary is a kind of ovarian cancer with a very low incidence.Its clinical manifestations are not obvious.The diagnosis should be based on the pathology and neuroendocrine indicators, and its primary nature should be determined.The main treatment is operation combined with platinum based chemotherapy.The survival period is related to clinical stage and treatment plan.The patient was hospitalized for 2 days because of the aggravation of abdominal distention and pain for half a year.The diagnosis of adnexal mass was confirmed by pathology.After three cycles of neoadjuvant chemotherapy (etoposide+ cisplatin), the patients underwent abdominal " total hysterectomy+ greater omentum resection+ appendectomy+ right pelvic wall peritoneal biopsy+ mesenteric biopsy" . After the operation, the patients received three cycles of EP chemotherapy, and they have been followed up for 15 months.

Neoplasia cervical intraepitelial tipo III, poshisterectomía supracervical laparoscópica: ventajas e inconvenientes de la conservación del cuello uterino en pacientes histerectomizadas / Cervical intraepithelial neoplasia type III after laparoscopic supracervical hysterectomy. Advantages and disadvantages of cervical conservation in hysterectomized patients

Resumen ANTECEDENTES: Existen múltiples opciones para practicar una histerectomía: por vía vaginal, abdominal laparotómica, laparoscópica o robótica. En pacientes que van a intervenirse por enfermedad benigna puede hacerse mediante la extirpación del cuerpo uterino (histerectomía parcial o supracervical). La preocupación por la posible aparición de una lesión neoplásica en el muñón cervical remanente ha dado lugar a investigaciones acerca de las ventajas de la exéresis del cuello uterino (histerectomía total). CASO CLÍNICO: Paciente de 36 años, intervenida para histerectomía supracervical con salpingectomía bilateral laparoscópica, por útero miomatoso sintomático. Posterior a la cirugía apareció una lesión preneoplásica de alto grado; se le indicó conización cervical. CONCLUSIÓN: Algunos expertos advierten que los riesgos de extirpar el cuello uterino son lo suficientemente notables como para optar por la técnica parcial en pacientes sin antecedentes de patología cervical, sobre todo si tienen cuadros adherenciales o endometriosis del tabique rectovaginal. Por el contrario, otros grupos indican que ante la baja tasa de complicaciones de la histerectomía total y la posibilidad de una patología neoplásica posterior, no está justificada la preservación cervical.

Abstract BACKGROUND: There are multiple approaches to perform a hysterectomy; the classic vaginal route, the laparotomic abdominal or the newest endoscopic techniques, such as laparoscopic or robotic. In patients undergoing benign pathology, the technique can only be performed by removing the uterine body (subtotal or supracervical hysterectomy). However, the concern about the possible occurrence of a neoplastic lesion in the remaining cervical stump has led to investigations into the benefits of also performing the cervical exeresis (total hysterectomy). Our goal is to present a review on the current situation of the topic, concluding that there is still no scientific consensus on which technique is the most recommended. CLINICAL CASE: 36-year-old woman who underwent supracervical hysterectomy with laparoscopic bilateral salpinguectomy due to symptomatic myomatous uterus. After surgery, he presented a high-grade preneoplastic lesion, which indicated that cervical conization was indicated. CONCLUSION: Some experts argue that the risks of performing the removal of the cervix are notable enough to indicate subtotal technique in patients without a history of cervical pathology, especially if they have adhesion or endometriosis of the rectovaginal septum. On the contrary, other working groups indicate that cervical preservation is not justified due to the low complication rate of the total hysterectomy technique and the possibility of developing a subsequent neoplastic pathology.

Effect of oxycodone for postoperative analgesia of laparoscopic total hysterectomy / 临床麻醉学杂志

Objective To observe the effect of oxycodone for postoperative patient-controlled intravenous analgesia of laparoscopic total hysterectomy with or without background infusion.Methods Seventy five patients, aged 40-65 years, BMI 18-24 kg/m2, ASA physical statusⅠ orⅡ, scheduled for elective laparoscopic total hysterectomy surgery under general anesthesia were randomly assigned into 3 equal groups (n = 25 each) using a random number table:morphine group (group M), oxycodone with background infusion group (group O1) and oxycodone without background infusion group (group O2).The anesthesia was induced by intravenous fentanyl 4μg/kg, propofol 2-2.5 mg/kg and cisatracurium 0.2 mg/kg.Group M was given morphine 50 mg+ondanstron 8 mg in100 ml normal saline, groups O1 and O2 were given oxycodone 50 mg+ ondanstron 8 mg in 100 ml normal saline.The PCIA pump of group M and group O1 were set up with a 0.5 ml bolus dose, a 5 min lockout interval and background infusion at a rate of 2 ml/h.Group O2 was set up with a 4 ml bolus dose, a 5 min lockout interval and without background infusion.The NRS scores of three groups at 4, 8, 12, 24 and 48 hafter operation were recorded.The total morphine or oxycodone consumption, and the number of rescue analgesia within 48 hafter surgery were recorded.The adverse events within 48 hafter surgery were also observed.Results Compared with group M, the NRS scores at rest were significantly decreased at 4, 8, and 12 hafter operation (P<0.05), and the NRS scores at movement were significantly decreased at 4 and 8 hafter operation (P<0.05), and the number of rescue analgesia within 48 hafter surgery was significantly decreased in groups O1 and O2 (P<0.05).The total analgesic consumption and the incidence of adverse event within 48 hafter surgery in group O2 were significantly lower than those in groups M and O1 (P<0.05).Conclusion Compared with morphine, oxycodone for patient-controlled intravenous analgesia can obtain more satisfactory effects after laparoscopic total hysterectomy surgery.Meanwhile, the total consumption of oxycodone and the incidence of nausea and vomiting are significantly decreased.

Comparison of application value of LTH and LAVH in hysterectomy / 中国内镜杂志

Objective To investigate the effect of total laparoscopic hysterectomy (LTH) and laparoscopic assisted vaginal hysterectomy (LAVH) for hysterectomy. Methods From February 2015 to February 2017, 182 patients with total hysterectomy were enrolled, among them, LTH was performed in 97 patients, and LAVH was performed in 85 patients, the operation time, intraoperative blood loss, the length of scar, postoperative anal exhaust time and so on were observed in the two groups, C reactive protein (CRP), interleukin -2 (IL-2) and IL-6 were detected before and after operation in two groups. Results In group LTH, the amount of bleeding and the length of scar were (104.33 ± 40.20) ml and (2.03 ± 0.84) cm respectively, which were significantly lower than those in group LAVH (P < 0.05); There was no significant difference between LTH group and LAVH group in postoperative anal exhaust time, hospital stay, postoperative analgesia and hospitalization costs (P > 0.05); The CRP and IL-6 in the LTH group postoperative were (26.43 ± 6.11) mg/L and (40.04 ± 11.03) ng/ml, significantly lower than those in LAVH group (P < 0.05), while IL-2 was (44.20 ± 12.29) ng/ml, was significantly higher than that of the control group (P < 0.05); The incidence of postoperative complications in LTH group was 6.19%, which was significantly lower than that of LAVH group (P < 0.05). Conclusion LTH is a safe and reliable method for hysterectomy, has the advantages of less complications, less influence on immune function and so on, is worthy of clinical application.

Effect of laparoscopic hysterectomy on vaginal microflora and the effect of lactobacillus intervention / 国际检验医学杂志

Objective To analyze the effect of laparoscopic hysterectomy on vaginal microflora and the effect of lactobacillus intervention.Methods 80 female patients undergoing laparoscopic hysterectomy in Wu-han University of Science and Technology Hospital from May 2014 to December 2016 were enrolled in the study.The patients were randomly divided into the observation group and the control group,40 cases in each group.The observation group received 3 courses of intervention with Live Lactobacillus Capule for Vsginal Use in 3 months after operation while the control group were not given any treatment.The rate of vaginal mi-croecological imbalance,the detection rate of lactobacillus,pH and female sexual function index(FSFI)were compared between the two groups.Results 2 month and 3 month after operation,there were significant differ-ences in the density of vaginal microflora,the diversity of vaginal microflora,the vaginal pH and the number of vaginal lactobacilli,compared with those before operation(P<0.05).3 month after operation,the above inde-xes were significantly better than those at 2 month after operation(P<0.05).After treatment,the rate of va-ginal microecological imbalance and vaginal pH value were lower in the observation group than the control group[37.50% vs.70.00%,(4.81 ± 0.26)vs.(5.16 ± 1.02)],while the detection rate of vaginal lactobacil-lus and FSFI score were higher than the control group[97.50% vs.57.50%,(81.14 ± 1.75)vs.(75.34 ± 1.18)](P<0.05).Conclusion Laparoscopic hysterectomy may affect vaginal microflora in the female,espe-cially 2 month after operation,the microecological environment is relatively poor.The application of Live Lac-tobacillus Capule for Vsginal Use can improve the vaginal microecological environment and the quality of sex-ual life,which is worth of clinical promotion.

Application of total hysterectomy in treatment of cervical intraepithelial neoplasia / 第二军医大学学报

Objective To investigate the clinical value of total hysterectomy in the treatment of cervical intraepithelial neoplasia. Methods We retrospectively analyzed the clinicaldata of 283 patients undergoing total hysterectomy for cervical intraepithelial neoplasia in Changhii Hospital of Second Military Medical University from Jan. 2009 to Dec. 2016. Among the patients, 206 cases received loop electrosurgical excision procedure CLEEP) before total hysterectomy (pre-operative LEEP group), 28 only received total hysterectomy directly after colposcopy biopsy (hysterectomy group) and 49 received LEEP during total hysterectomy (intra-operative LEEP group). The changes of pathological grade and the lesion residual rates of the patients before and after operation were compared. The effect of clinicopathological features (age, pregnancy times, partus times, abortion times, menopausal years, pathology, human papilloma virus (HPV) infection, tumor family history and so on) on postoperative residual lesion were analyzed by univariate and multivariate analysis. Results The cure rate, lesionresidual rate, pathological downgrade rate and pathological upgrade rate in the pre-operative LEEP group was 35. 92%(74/206), 64. 08%(132/206), 63. 11% (130/ 206) and 3. 88% (8/206), respectively, and two cases with canceration were found. In the hysterectomy group, the consistent rate of pathological diagnosis before and after operation, pathological downgrade rate and pathological upgrade rate were 57. 14%(16/28), 35. 71 %(10/28) and 7 14%(2/28), respectively, and one case with invasive carcinoma was found after operation. The lesion residual rate, pathological downgrading rate and pathologicil upgrading rate in the intra- operative LEEP group were 40. 82% (20/49), 65. 31% (32/49) and 8. 16% (4/49), respectively, and two cases with invasive carcinoma were found after operation. Univariate analysis showed that age and menopausal years were the factors influencing lesion remaining after LEEP (P<0. 05). Multivariate analysis showed that patients with longer menopausal years had lower risk of lesion remaining (P = 0. 02). The pregnancy times, partus times, abortion times, lesion involving glands, positive margins, HPV infection and family history of cancer had no significant effects on postoperative lesion remaining. Conclusion Total hysterectomy plays an important role in preventing the recurrence of cervical precancerous lesion and reducing the incidence of invasive carcinoma. It is suitable for people with few screening opportunities, poor follow-up conditions and no fertility requirements. Patients with high grade intraepithelial lesion who are not menopausalor have short menopausal years need to be followed up more closely and can receive total hysterectomy if necessary.

Effect of general anesthesia combined with epidural anesthesia on analgesia and microcirculation in patients undergoing total hysterectomy / 中国生化药物杂志

Objective To study effect of general anesthesia combined with epidural anesthesia on analgesia and microcirculation in patients undergoing total hysterectomy. Methods 92 patients of total hysterectomy who received therapy were selected, according to random number table,those patients were divided into the observation group (n=42) and the control group (n=48),the observation group received general anesthesia combined with epidural anesthesia, the control group were only given general anesthesia.The operation condition, hemodynamics and stress response before anesthesia(T0), at tracheal intubation(T1), after pneumoperitoneum 10min(T2), after surgery(T3), at extubation(T4) were compared,and postoperative pain (VAS) score was compared. Results There was no significant difference in operation time and fluid volume between the two groups. In the control group,the levels of mean arterial pressure (MAP), heart rate (HR) at the time of T1, T2, T3 were significantly increased(P<0.05), the levels of MAP and HR at the time of T1,T2,T3 in the observation group were lower than the control group(P<0.05). The cortisol (Cor), epinephrine (E), norepinephrine (NE) at the time of T1,T2,T3,T4 in the observation group were lower than the control group(P<0.05). Two groups of patients in the postoperative 12h, 6h, the VAS scores in the resting state and cough state were higher than the postoperative 1h(P<0.05),but the scores in the observation group were lower than the control group(P<0.05). Conclusion General anesthesia combined with epidural anesthesia is well for total hysterectomy,which can maintain hemodynamic stability during surgery, relieve stress reaction, alleviate postoperative pain, it is worthy of application and promotion.

Clinical study on the effect of transvaginal total hysterectomy under combined spinal epidural anesthesia / 中国生化药物杂志

Objective To analyze the effect of transvaginal total hysterectomy under combined spinal epidural anesthesia. Methods From December 2015 to December 2016, in Longde people's hospital 80 cases underwent transvaginal total hysterectomywere randomly divided into two groups, he observation group and the control group. The control group was treated with continuous epidural anesthesia, the observation group were given combined spinal epidural anesthesia. The anesthesia effect and VAS scores were observed and compared. Results The excellent rate of anesthesia in the observation group was 95%, which was significantly higher than 75% in the control group(P<0.05). 1h after anesthesia, there was no statistically significant difference in the cough and static state VAS scores between the 2 groups; 6 and 12 hours after anesthesia, the cough and static state VAS scores was significantly better than those in the control group(P<0.05). Conclusion Compared with epidural anesthesia, combined spinal epidural anesthesia for vaginal total hysterectomy has a better anesthetic and analgesic effect, anesthesia safety is high, it is worthy of clinical application.

Clinical Effect of Abdominal Total Hysterectomy on Uterine Fibroids and Serum VEGF, IL-6 and IL-8 Levels / 现代生物医学进展

Objective:To research the clinical effect of abdominal total hysterectomy on the patients with uterine fibroids and the serum vascular endothelial growth factor (VEGF) and interleukin 6 (IL-6),interleukin 8 (IL-8) levels.Methods:106 cases of patients with uterine fibroids from February 2014 to February 2016 were divided into the control group and the research group according to the lottery method,the control group was treated with total abdominal hysterectomy,while the research group was given abdominal total hysterectomy treatment,the operation time,blood loss,anal exhaust time,length of hospital stay,changes of serum VEGF,IL-6,IL-8,Follicle stimulating hormone (FSH),estradiol (E2) levels,resistance to seedling le tube hormone (AMH) before and after the surgery as well as the occurrence of complications were compared between two groups.Results:The operation time,blood loss,length of hospital stay,anal exhaust time of research group were significantly shorter than those of the control group (P＜0.05).Before surgery,the serum levels of VEGF,IL-6,IL-8,FSH,E2,AMH showed no difference between two groups (P＞0.05).After the operation,the serum levels of IL-6,IL-8,E2,AMH of research group were lower than those of the control group (P＜0.05),the serum level of FSH in research group was higher than that of the control group (P＜0.05).The serum level of VEGF showed no difference between the two groups (P＞0.05).The incidence rate of complications in research group was lower than that of the control group (P＜0.05).Conclusion:Abdominal total hysterectomy showed similar effect with the abdominal hysterectomy in the treatment of uterine fibroids patients,but the abdominal full hysterectomy induced less trauma,promoted the recovery of ovarian function after surgery,which might be related to the decrease of serum IL-6,IL-8 and VEGF levels.

Embarazo ectópico abdominal / Abdominal ectopic pregnancy

Se presenta un caso de embarazo ectópico abdominal del segundo trimestre, que se diagnosticó en el curso de una complicación relacionada con hemoperitoneo y que fue necesario realizarle histerectomía total con anexectomía izquierda. Se revisan aspectos de su etiología, diagnóstico y tratamiento. Es el segundo caso publicado por el autor principal.

A case of abdominal ectopic pregnancy is presented in its second quarter and was diagnosed in the course of a complication related to the hemoperitoneum. It was necessary to perform a total hysterectomy with left oophorectomy. Aspects of etiology, diagnosis and treatment are reviewed. It is the second case reported by the leading author.

Total hysterectomy of laparoendoscopic single site surgery / 中华妇产科杂志

Objective To explore the operation skills of laparoendoscopic single site surgery ( LESS) of total hysterectomy , to expand the application of LESS in the field of in gynecologic surgery . Methods A total of 23 cases of total hysterectomy were completed under laparoendoscopic single site surgery in Peking Union Medical College Hospital from January 2012 to August 2013, applying with combination of the traditional laparoscopic and special LESS apparatuses , intelligent electronic coagulation and excision device and the self-fixed absorbable sutures ( V-LOC).The datas of the patients during the operations and the follow-up were recorded and analyzed Results Twenty-three cases LESS-TH are accomplished.The weight of uterus was (230+38) g.The operation time was (73+22) minutes, with the intraoperative blood loss (99 ±53) ml.The postoperative intestinal function recovery time was (13 +4) hours, and postoperative hospitalized time was ( 1.8 ±0.6 ) days, with the postoperative pain visual analogue scale 3.9 ±1.6.There were no complications reported during intraoperative and postoperative time.All of our patients was finished the follow-up from 14 d to 2 months.As usual, vaginal discharge is normal, wound healed well, most of the wounds healing (19/23) hidden in umbillicus, no obvious scar, vaginal stub wound healed well Conclusions ( 1 ) LESS can accomplish total hysterectomy of uterus of gestational age less than 8 weeks safely and effectively .( 2 ) Combination of traditional laparoscopic and special LESS appatatuses , the use of intelligent energy devices and V-LOC to suture vaginal stub could make the total hysterectomy by LESS much easier and safer .

Algunos resultados de la histerectomía total abdominal & histerectomía subtotal abdominal en pacientes con diagnóstico de mioma uterino / Some results from the abdominal total and subtotal hysterectomy in patients diagnosed with uteri myoma

La controversia entre todas las formas de histerectomías y sus diferentes abordajes se ha agudizado, ha llegado a las propias pacientes que con frecuencia creciente solicitan información del ginecólogo, llegan a exigir la histerectomía subtotal abdominal (HSTA) por la ventajas que han oído o leído sobre ella. OBJETIVO: Analizar comparativamente resultados obtenidos entre la histerectomía total abdominal (HTA) y la histerectomía subtotal abdominal (HSTA), según variables seleccionadas. MÉTODOS: Se realizó un estudio descriptivo retrospectivo longitudinal en el periodo comprendido entre enero 2002 a diciembre 2004 en el Hospital Ginecoobstérico Docente Ramón González Coro. La muestra estuvo constituida por un total 310 pacientes histerectomizadas con el diagnóstico de mioma uterino para lo cual seleccionamos dos grupos. Para investigar la posible asociación entre variables cualitativas se utilizó la prueba chi², se consideraron diferencias significativas en aquellos casos donde p = 0,05. RESULTADOS: La HSTA tuvo menor tiempo quirúrgico para un 83,9 por ciento (p=0,000), así como una menor estadía hospitalaria para un 58,1 por ciento, el sangramiento moderado fue de un 5,1 por ciento en la HSTA, no se encontraron lesiones a órganos vecinos en ambos grupos, y la morbilidad febril e infecciosa fue mayor para el grupo de la HTA para un 22,4 por ciento y 5,7 por ciento respectivamente. CONCLUSIONES: En nuestro estudio la histerectomía subtotal abdominal comparativamente con la histerectomía total abdominal tuvo menor tiempo quirúrgico, estadía hospitalario y menor número de complicaciones transoperatorias y posoperatorias

Controversy among all the ways of hysterectomies and the different approaches has increased is known by patients that frequently request information to gynecologists on their criterion of an abdominal subtotal hysterectomy (ASTH) due its advantages of this technique. OBJECTIVE: To analyze comparatively the results obtained among the abdominal total hysterectomies (ATH) and the ASTH according the variables selected. METHODS: A cross-sectional, retrospective and descriptive was conducted from January, 2002 to December, 2004 in the Ramón Pando Ferrer Genecology-Obstetricts Hospital. Sample included 310 patients with hysterectomy diagnosed with a uterine myoma divided into two groups. To research the possible association among qualitative variable the chi² test was used with significant differences en those groups where (p =0.05). RESULTS: The ASTH had less surgical time for a 83.9 percent (p = 0,000), as well as a lower hospital stay for 58.1 percent; moderate bleeding was of a 5.1 percent in the ASTH without lesions of surrounding organs in both groups and febrile and infectious morbidity was greater for the ATH group for a 22.4 percent and 5.7/5, respectively. CONCLUSIONS: In our study the abdominal subtotal hysterectomy (ASBH) compared with the abdominal total hysterectomy (ATH) has less surgical time, hospital stay and a lesser number of transoperative and postoperative complications

Effect of Different Surgical Approaches to Hysterectomy on the Sexual Function and Psychological Health / 中国医科大学学报

Objective To compare the effects of transabdominal hysterectomy(TAH),transvaginal hysterectomy(TVH),and laparoscopic total hysterectomy(LTH)on sexual function and psychological health.Methods A total of 100 patients undergoing TAH,100 patients undergoing TVH,and 40 patients undergoing LTH were followed up for 1 year.All the patients were aged between 45 and 54 years.The Results of the questionnaire on sexual function and psychological health were analyzed and compared with those from 100 control subjects undergoing hysteromyomectomy.Results In pateints under 50 years of age,no significant difference in the sexual function and psychological health was found between control group and any one of TAH,TVH,and LTH goups.In patients aged 50 yeare and older.ESFI score decreased from control group to TVH group to LTH group to TAH group;CHQ-12 score increased from control group to TVH group to LTH group to TAH group;and there was significant difference in the FSFI and CHQ-12 scores both between TAH and control groups and between TAH and TVH groups(P＜0.05).Conclusion There is no obvious effect of these 3 surgical approches to hysterectomy on the sexual function and psychological health in patients under 50 years of age,and there is no significant difference in the sexual function and psychological health among these 3 surgcial approaches.In patients aged 50 yean;and older,TAH has a negative impact on the psychological health and sexual function.

The research in the effect of early systemic nursing intervention on the lime of indwelling urethral catheter after surgery of uterine cervix cancer / 中国实用护理杂志

Objective Through early systemic nursing intervention of cervical cancer patients for promotion of the recovery of urinary bladder function, to remove the urethral catheter in advance,and reduce the occurrence of urinary bladder dysfunction. Methods 80 cervical cancer patients after total hysterectomy were divided into the treatment group and the control group with 40 cases in each group stochastically. The treatment group was given systemic nursing( psychological nursing,pelvis bottom muscles exercising,urination discontinuance exercising,abdominal muscle exercising,Valsalva maneuver exercising, Crede press exercising,open the urethral catheter timely and individually,cheiropractic with hot roller), the control group received conventional nursing and some simple training of urinary bladder function. The time of indwelling urethral catheter after the hysterectomy was compared. Results The time of indwelling urethral catheter in the treatment group and in the control group were (9.65±49)days and (15.88±03)days respectively. The incidence rate of residual urine,urine retention and infection of urinary system after surgery in the treatment group was lower than that of the control group. Conclusions Early systemic nursing intervention can shorten the time of indwelling urethral catheter after hysterectomy, reduce the occurrence of urinary bladder dysfunction .improve the surgery effect for the cervical cancer patients and ameliorate their quality of life.

Postoperative Pain Control using Intravenous Patient Controlled Analgesia in Cesarean Section and Hysterectomy / 대한마취과학회지

BACKGROUND: Postoperative pain degree is variable according to the site, type, and method of operation. This study compared the pain degree and amount of analgesics required among 3 types of operation. METHODS: Ninety patients were selected that cesarean section (Group I, n = 30), open total hysterectomy (Group II, n = 30), laparoscopic total hysterectomy (Group III, n = 30) were scheduled. Patients received PCA with basal rate 2 ml/h, bolus 1 ml, lockout interval 5 min using fentanyl and ketorolac. We evaluated VAS at 30 min, 2, 6, 12, 18, 24, 36, 48 h postoperatively, demand of button and attempt of button, 6 hourly used amount of analgesics; side effects and degree of satisfaction after 24, 48 h postoperatively. RESULTS: The rest VAS decreased below 30 at 6 hr in group I & II and at 2 hr in group III. More analgesics were needed for the first 6 hr compared with remained time in 3 groups (group I vs. group II vs. group III, P < 0.05). Total amount of analgesics including loading dose were fentanyl 1,536 +/- 342microgram, ketorolac 167 +/- 34 mg for group I; 1,212 +/- 215microgram, 132 +/- 30 mg for group II; 866 +/- 125microgram, 97 +/- 27 mg for group III (group I vs. group II vs. group III, P < 0.05). CONCLUSIONS: The postoperative pain was painful as order of cesarean section, open total hysterectomy, and laparoscopic total hysterectomy. The pain was reduced 6 hr in laparotomy and 2 h in laparoscopy.