目的:探讨中度宫腔粘连患者宫腔粘连电切术(transcervical resection of adhesion,TCRA)后不同防粘连方式对生殖预后的影响。方法:193例中度宫腔粘连患者TCRA术后使用雌孕激素周期治疗,按术后防粘连方式分为球囊+上环组(79例)、单独球囊...目的:探讨中度宫腔粘连患者宫腔粘连电切术(transcervical resection of adhesion,TCRA)后不同防粘连方式对生殖预后的影响。方法:193例中度宫腔粘连患者TCRA术后使用雌孕激素周期治疗,按术后防粘连方式分为球囊+上环组(79例)、单独球囊组(60例)和单独凝胶组(54例)。调查患者的妊娠率、活产率、重复电切率,妊娠结局和产时并发症。结果:有生育要求者184例,共有126例妊娠(妊娠率68.48%),3组妊娠率(72.37%、75.86%、54.00%)差异有统计学意义(P=0.032)。3组活产率(46.05%、50.00%、30.00%)差异无统计学意义(P=0.086)。3组流产、早产、足月产率差异均无统计学意义;各组产后出血、胎盘粘连、前置胎盘、胎盘植入等并发症的发生率差异也均无统计学意义。结论:中度宫腔粘连患者TCRA术后不同防粘连方式生殖预后总体并无明显差异,但在术后妊娠率和活产率上,球囊+上环和单独球囊组可能高于单独凝胶组。展开更多
Large size peritoneal trauma from extended surgery for high-grade expansive uterus pathology or endometriosis might result in severe diffuse bleeding and peritoneal adhesion formation with objectionable sequelae. This...Large size peritoneal trauma from extended surgery for high-grade expansive uterus pathology or endometriosis might result in severe diffuse bleeding and peritoneal adhesion formation with objectionable sequelae. This paper introduces 4DryField®?PH polysaccharide powder certified for two indications: 1) given as powder 4DryField®?PH provides hemostasis;2) transformed into gel, 4DryField®?PH forms an adhesion prevention barrier. Twenty-one women with expanded uterus pathology and/or deep infiltrating endometriosis had surgery including repair of intestine lesions (n = 8), ureterolysis/repair of bladder, including retrograde ureteric stents (n = 5). Subjective impression of hemostatic effect, drain loss and infection parameters were recorded. Six women had scheduled second look laparoscopy. 4DryField®?PH applied as powder showed an immediate significant hemostatic effect in all instances, especially in profound diffuse bleeding. Mean drain loss was 497 ± 339 mL, moderate considering the extent of disease. Dripped with saline solution, 4DryField®?PH immediately formed a viscous gel acting as a barrier for adhesion prevention. Second look laparoscopy revealed only one patient with significant adhesions. No adverse events were observed;discharge was at Day 6.2 ± 1.4. In this cohort with extended gynecological laparoscopic surgery 4DryField®?PH was very effective for hemostasis. The results of second look laparoscopies showed mainly no or minor adhesions. This can be considered very favorable regarding the extent of disease in these patients. Considering the twofold effect in hemostasis and adhesion prevention, 4DryField®?PH is a very helpful tool especially in extensive and complicated surgeries. Prospective randomized studies are necessary to prove these promising results in larger series.展开更多
文摘目的:探讨中度宫腔粘连患者宫腔粘连电切术(transcervical resection of adhesion,TCRA)后不同防粘连方式对生殖预后的影响。方法:193例中度宫腔粘连患者TCRA术后使用雌孕激素周期治疗,按术后防粘连方式分为球囊+上环组(79例)、单独球囊组(60例)和单独凝胶组(54例)。调查患者的妊娠率、活产率、重复电切率,妊娠结局和产时并发症。结果:有生育要求者184例,共有126例妊娠(妊娠率68.48%),3组妊娠率(72.37%、75.86%、54.00%)差异有统计学意义(P=0.032)。3组活产率(46.05%、50.00%、30.00%)差异无统计学意义(P=0.086)。3组流产、早产、足月产率差异均无统计学意义;各组产后出血、胎盘粘连、前置胎盘、胎盘植入等并发症的发生率差异也均无统计学意义。结论:中度宫腔粘连患者TCRA术后不同防粘连方式生殖预后总体并无明显差异,但在术后妊娠率和活产率上,球囊+上环和单独球囊组可能高于单独凝胶组。
文摘Large size peritoneal trauma from extended surgery for high-grade expansive uterus pathology or endometriosis might result in severe diffuse bleeding and peritoneal adhesion formation with objectionable sequelae. This paper introduces 4DryField®?PH polysaccharide powder certified for two indications: 1) given as powder 4DryField®?PH provides hemostasis;2) transformed into gel, 4DryField®?PH forms an adhesion prevention barrier. Twenty-one women with expanded uterus pathology and/or deep infiltrating endometriosis had surgery including repair of intestine lesions (n = 8), ureterolysis/repair of bladder, including retrograde ureteric stents (n = 5). Subjective impression of hemostatic effect, drain loss and infection parameters were recorded. Six women had scheduled second look laparoscopy. 4DryField®?PH applied as powder showed an immediate significant hemostatic effect in all instances, especially in profound diffuse bleeding. Mean drain loss was 497 ± 339 mL, moderate considering the extent of disease. Dripped with saline solution, 4DryField®?PH immediately formed a viscous gel acting as a barrier for adhesion prevention. Second look laparoscopy revealed only one patient with significant adhesions. No adverse events were observed;discharge was at Day 6.2 ± 1.4. In this cohort with extended gynecological laparoscopic surgery 4DryField®?PH was very effective for hemostasis. The results of second look laparoscopies showed mainly no or minor adhesions. This can be considered very favorable regarding the extent of disease in these patients. Considering the twofold effect in hemostasis and adhesion prevention, 4DryField®?PH is a very helpful tool especially in extensive and complicated surgeries. Prospective randomized studies are necessary to prove these promising results in larger series.
