[Influence of previous abdominopelvic surgery on gynecological laparoscopic operation].

OBJECTIVE: To investigate the influence of previous abdominopelvic surgery on gynecological laparoscopic operation. METHODS: A retrospective analysis of 3 283 cases of gynecological diseases by laparoscopic operation patients in Peking University First Hospital from 2007 January to 2012 December, among them, 719 (21.90%) patients with previous abdominopelvic surgery history (study Group), 2 564 (78.10%)patients have no history of abdominopelvic surgery (control group). Study group 719 patients, previous operation times: one time in 525 cases, 194 cases were multiple; previous operation: 185 cases of gynecological surgery, 305 cases of obstetric surgery, 108 cases of general surgery, and 121 complex surgery (include at least two kinds of surgery); previous operative approach: 650 cases laparotomy and 69 cases laparoscopy. Compared two groups of patients with abdominopelvic adhesion and the gynecologic laparoscopic operation situation, analyzed the influence of previous abdominopelvic surgery on abdominopelvic adhesion on and gynecological laparoscopic operation. RESULTS: The incidence of abdominopelvic adhesion in the patients with previous abdominopelvic surgery was 51.2% (368/719), which was significantly higher than that of 8.2% (211/2 564)in patients without previous abdominopelvic surgery (P < 0.01). But the study group score (median 3) and the degree of abdominopelvic adhesion [mild 49.7% (183/368), moderate 36.1% (133/368), severe 14.1% (52 /368)] compared with the control group score (median 2) and degree [mild 55.0% (116/211), moderate 25.6% (54/211), and severe 19.4% (41/211)] were no statistical difference (P = 0.930, P = 0.684). Super-umbilical primary trocar site were chosen more common in patients with previous abdominopelvic surgery (23.1%, 166/719) was significantly higher than that in the control group (3.3% , 85/2 564;P < 0.01). And the rate of conversion to laparotomy was 0.6% (4/719) significantly more than the control groups (0.1%, 2/2 564; P = 0.023). Compared with other groups, patients with gynecological or complex surgery or multiple operation history presented more severe abdominopelvic adhesion both in the score and degree (P < 0.01). The rate of super-umbilical primary trocar site, hospitalization time, operation time and bleeding during operation in patients with multiple operation history were significantly higher than those with single operation history (P < 0.05); the rate of blood transfusion, postoperative complication and conversion to laparotomy showed no statistical difference between the two groups (P > 0.05). CONCLUSION: The laparoscopic operation could be carried out successfully and safely in patients with a history of various abdominopelvic operations, but the conversion rate increases, for patients with a history of multiple operation because of pelvic adhesion increases the difficulty of the laparoscopic operation.

[Comparison of multiple pregnancy rate following transfer of frozen-thawed or fresh embryos and analysis of related factors].

OBJECTIVE: To compare the multiple pregnancy rates of frozen-thawed embryos transfer (FET) or fresh embryos transfer, analyze the factors related to multiple pregnancies after IVF and study pregnancy rates with different number of embryos transferred in FET cycle. METHODS: A retrospective analysis was performed upon multiple pregnancies from 1235 and 1561 clinical pregnancies conceived by FET or fresh embryo transfers. RESULTS: No correlation was found between fresh or cryopreserved embryos transfer and multiple pregnancy rates. There were significant effects of woman's age, number of embryos transferred and stage of embryos upon multiple pregnancy rates. When the same number of cleavage-stage embryos was transferred to women with the same age, twin pregnancy rate or triplet pregnancy rate was the same between FET and fresh cycles. Triplet pregnancy rate with three embryos transferred was significantly higher than that of two embryos transferred. In women under 35 years old, the pregnancy rate with two embryos transferred reached 36.1%. CONCLUSION: Frozen-thawed embryos or fresh embryos transfer has no effect upon the multiple pregnancy rate. Women under 35 years old can achieve acceptable pregnancy rates when two cryopreserved embryos are transferred. It is helpful to reduce the triplet pregnancy rate.