ObjectiveTo investigate the effectiveness of the tubal reconstruction after laparoscopic tubal pregnancy operation by comparing with simple laparoscopic tubal pregnancy operation. MethodsBetween May 2007 and May 2010, 63 patients with tubal pregnancy underwent laparoscopic tubal pregnancy operation and tubal reconstruction in 30 cases (trial group) or simple laparoscopic tubal pregnancy operation in 33 cases (control group). There was no significant difference in age, pregnancy time, and position between 2 groups (P gt; 0.05). The tube patency test and hysterosalpingography (HSG) were carried out to evaluate the efficacy. ResultsThe operation was successfully completed in 29 cases of trial group; 1 case had too severe adhesion to receive re-anastomosis and was excluded. The tube patency test showed that the tube was patency in 26 cases of trial group and in 2 cases of control group during operation, showing significant difference (Z=5.86, P=0.00); it was patency in 25 cases of trial group and in 26 cases of control group at 1 month after operation, showing no significant difference (Z=0.48, P=0.63). HSG examination showed tube was patency in 25 cases of trial group and in 2 cases of control group at 2 months after operation, showing significant difference (Z=5.35, P=0.00). After 24 months, intrauterine pregnancy of trial group (n=25, 86.20%) was significantly higher than that of control group (n=19, 57.58%) (χ2=7.72, P=0.01). ConclusionThe reconstruction after laparoscopic tubal pregnancy operation can significantly increase the intrauterine pregnancy rate, and it is better than simple laparoscopic tubal pregnancy operation.
Objective To investigate influence of iodine-131 (131I) treatment following total thyroidectomy on menstrual rhythm and fertility of childbearing age patients with papillary thyroid carcinoma (PTC). Methods The clinical data of 342 childbearing age patients with PTC treated with total thyroidectomy from January 2007 to December 2016 in the First Affiliated Hospital of Xinjiang Medical University were retrospectively analyzed. The patients were designed to 131I treatment group (126 cases) and non-131I treatment group (216 cases) according to the postoperative treatment. The menstrual rhythm and pregnancy after operation were regularly followed-up on postoperative 1 month. The age, nationality, occupation, menstrual rhythm, and pregnancy were analyzed by two independent samples t or Chi-square or Fisher test. Results ① There were no significant differences in the age, nationality, and occupation between the 131I treatment group and the non-131I treatment group (P>0.05). ② Compared with the non-131I treatment group, the proportions of the irregular menstruation were significantly increased on the 1st month and 3rd month of follow-up (P<0.05) in the131I treatment group, which had no statistically significant differences on the 6th month and 12th month of follow-up in two groups (P>0.05). Further the analysis results of the age stratification showed that had no significant differences at different follow-up time in these two groups (P>0.05). ③ The success rate of pregnancy also had no significant differences in these two groups both in the general and the age stratification analysis results (P>0.05). Conclusions 131I treatment following total thyroidectomy can affect menstrual rhythm of women in childbearing age at the early stage (within 6 months), but there is no abnormal menstruation on 6 months later, which dosen’t effect on pregnancy in women of childbearing age, and it is recommended that pregnancy should be renewed in 1-year after 131I treatment.
Objective To summarize the characteristics and management of pregnancy complicated with aortic dissection, and to explore the reasonable diagnosis and treatment plan. Methods The clinical data of 10 patients of pregnancy complicated with aortic dissection in Wuhan Tongji Hospital from January 2011 to June 2017 were collected. Their age was 25.2 (21-29) years. Results In the 10 patients, the majority (8 patients) were primipara, and most of them were in the late stages of pregnancy (5 patients) and puerperal (4 patients). Among them, 1 patient had gestational hypertension, and the blood pressure of the left and right upper extremities was significantly abnormal (initial blood pressure: left upper limb blood pressure: 90/60 mm Hg, right upper limb blood pressure: 150/90 mm Hg). The major clinical manifestations were severe chest and back pain which happened suddenly, with D-dimmer and C-creative protein increased which may be associated with inflammatory reaction. All patients were diagnosed by thoracoabdominal aortic CTA, including 5 patients of Stanford type A dissection and 5 patients of Stanford type B dissection. In the 10 patients, 1 patient refused surgery and eventually died of aortic rupture with the death of fetus before birth. And the remaining 9 patients underwent surgical treatment, 3 patients of endovascular graft exclusion for thoracic aortic stent graft, 2 patients underwent Bentall operation, 1 patient with Bentall + total aortic arch replacement + vascular thoracic aortic stent graft, 1 patient with Bentall operation combined with endovascular graft exclusion for thoracic aortic stent graft, 1 patient with Bentall + coronary artery bypass grafting, 1 patient of thoracoabdominal aortic vascular replacement. Among them, 1 patient underwent endovascular graft exclusion for thoracic aortic stent graft died of severe postoperative infection, and the remaining 8 patients were discharged from hospital. Nine patients were single birth, among them 5 newborn patients had severe asphyxia, 4 patients had mild asphyxia. Finally, 3 neonates died of severe complications, and the remaining 6 survived. Conclusion The ratio of pregnancy with Stanford type A aortic dissection is far higher than in the general population, the possibility of fetal intrauterine asphyxia is larger, but through active and effective surgical and perioperative treatment, we can effectively save the life of mother and fetus.
Pregnancy complicated by aortic root aneurysm in patients with Marfan syndrome is one of the main causes of termination of pregnancy or even death in pregnant women. A very small number of pregnant women require cardiac surgery to preserve pregnancy under extracorporeal circulation, and all surgeries use aortic root replacement. We reported a 30-year-old patient with severe aortic regurgitation combined with giant aortic root aneurysm and Marfan syndrome in mid-pregnancy. Valve-sparing root replacement using reimplantation technology was performed via a multidisciplinary cooperation model. This not only achieved the patient’s desire to continue pregnancy but also avoided the anticoagulation and bleeding complications brought by mechanical valve replacement, reduced pregnancy risks and improved long-term quality of life. Postoperative echocardiography showed a small amount of aortic valve regurgitation, aortic valve coaptation height of 0.6 cm, effective height of 1.1 cm, maximum aortic flow velocity of 1.4 m/s, mean transvalvular pressure gradient of 4.4 mm Hg, and satisfactory clinical results.
ObjectiveTo compare the clinical efficacy of methotrexate perfusion combined with interventional treatment and the traditional treatment with methotrexate and mifepristone for cesarean scar pregnancy. MethodA total of 589 patients diagnosed with cesarean scar pregnancy after surgery between January 2012 and March 2015 in our hospital were selected to be our study subjects. The patients were informed of the two kinds of treatment, and based on their own will, they were arranged into corresponding groups. Group A had 234 patients who were willing to undergo the conventional therapy:intramuscular injection of methotrexate (20 mg, once per day for 5 days); oral mifepristone (50 mg once per day for 3 to 5 days); and the continuation of drugs was determined by local pregnancy tissue blood flow on B ultrasound and liver function of the patients. Group B had 255 patients who selected uterine artery perfusion and arterial embolism. There was no significant difference in terms of age, serum human chorionic gonadotrophin (HCG) and uterine incision gestation sac size between the two groups of patients (P>0.05). Then we compared the treatment effect between the two groups. ResultsThe differences in the amount of bleeding, the time of blood HCG dropped to normal, and hospitalization duration between the two groups were significant (P<0.05), while in the rate of hysterectomy, drug-induced liver injury were not (P<0.05). ConclusionsMethotrexate perfusion combined with interventional treatment is better than the traditional treatment with methotrexate and mifepristone for cesarean scar pregnancy in terms of clinical efficacy and safety.
Objective To study the clinical value and surgical procedure of laparoscopic operation for interstitial tubal pregnancy. Methods Clinical data of 36 patients of interstitial tubal pregnancy treated by laparoscopic operation were retrospectively analyzed. Results All 36 patients were operated successfully, without conversions to laparotomy and intra- or post- operative complications. The operation time was 28-85 min(mean, 41min), and the length of stay in hospital postoperative was 3-6 d (mean, 4-5 d). Conclusion Laparoscopic operation for interstitial tubal pregnancy is safe and feasible.
ObjectiveTo observe and analyze the risk factors of retinopathy in patients with hypertension in pregnancy.MethodsA retrospective clinical study. From January 2018 to December 2019, 260 patients with hypertension during pregnancy who were hospitalized in the Obstetrics Department of the Third Affiliated Hospital of Guangzhou Medical University were included in the study. All patients underwent fundus color photography examination. Their age, gestational age, course of hypertension, past history, number of pregnancy and childbirth, pre-pregnancy body mass index (BMI) and laboratory blood routine, alanine aminotransferase, aspartate aminotransferase, and urea Nitrogen, creatinine, uric acid, serum albumin concentration, and 24-hour urine protein concentration and urine protein content examination results were collected. Among the 260 patients, there were 60 and 200 patients with or without retinopathy in the fundus, respectively. Patients were divided into retinopathy group and no retinopathy group. The comparison of quantitative data between groups was performed by independent sample t test; the comparison of grade data was performed by Mann-Whitney U nonparametric test. The variable with statistical difference between the two groups was the independent variable, and the two-class logistic regression analysis was performed.ResultsGestational week (t=4.875), pre-pregnancy BMI (t=2.779), highest systolic blood pressure (t=－4.799), lowest systolic blood pressure (t=－4.797), highest diastolic blood pressure (t=－4.226), minimum diastolic blood pressure (t=－4.226), low and high platelet values and their fluctuations (t=7.701, 2.504, －6.083), serum albumin concentration (t=13.255), aspartic acid transaminase (t=－2.272), urea nitrogen (t=－5.117), creatinine (t=－2.735), uric acid (t=－2.130), 24-hour urine protein concentration (t=－7.801) and 24-hour urine protein (t=－7.567) were compared. The difference was statistically significant (P＜0.05). Logoistic regression analysis showed that pre-pregnancy BMI, maximum systolic blood pressure, low platelet value, and serum albumin were related to the occurrence of retinopathy of hypertension in pregnancy (P＜0.05).ConclusionHigh systolic blood pressure, low platelets, and low serum albumin are the risk factors for the occurrence of retinopathy of hypertension in pregnancy.
Objective To compare the surgical outcome and investigate the clinic value between laparoscopic operation and laparotomy in the treatment of ectopic pregnancy. Methods We searched PubMed, EMbase, SCI, The Cochrane Library, Chinese Biomedical Literature Database, China Journal Full Text Database, Chinese Medical Association Journals, and references of the included studies up to April 2009. Studies involving treatment outcome of ectopic pregnancy using laparoscopy compared with laparotomy were included. Data were extracted and methodological quality were evaluated by two reviewers independently with designed extraction form. The Cochrane Collaboration’s RevMan 5.0.1 software was used for data analyses. Results A total of 11 studies involving 1795 patients were included. The results of meta-analyses showed that laparoscopy comparing with laparotomy; the operation time and complications had no difference; intraoperative blood loss was less than laparotomy; intestinal gas exhaust and evacuation active time was earlier than laparotomy. Conclusion Laparoscopy treating for ectopic pregnancy is better than laparotomy. It is a minimally invasive surgical technique, and is worthy to be popularized.
ObjectiveTo investigate the multidisciplinary management of patients with acute type A aortic dissection in late pregnancy.MethodsThe clinical data of 3 patients admitted to the Second Affiliated Hospital of Army Medical University from 2018 to 2019 were analyzed. Their age ranged from 27 to 32 years, while gestational age was 34-37 weeks. Sudden chest pain was the main clinical symptom before operation. All 3 patients underwent Bentall surgery after cesarean section under general anesthesia, of whom 2 patients received total arch replacement (TAR) combined with frozen elephant trunk (FET) implantation and 1 received coronary artery bypass grafting (CABG) additionally.ResultsNo patient died during the perioperative period, and all the newborns were delivered successfully and survived healthily. The ICU stay was 3-5 d. The postoperative hospital stay was 15-18 d. The follow-up was 250-751 d. There was no recurrence or death. One patient who developed spontaneous pneumothorax and hydropneumothorax was cured in our center.ConclusionThe multidisciplinary diagnosis and treatment strategy plays a crucial role in saving the life of pregnant patients with acute type A aortic dissection.
ObjectiveTo systematically review the effects of assisted reproductive technology in single pregnancy on the incidence of gestational diabetes.MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect cohort studies on the correlation between assisted reproductive technology (ART) and gestational diabetes mellitus (GDM) incidence in single pregnancy from inception to June 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed by using RevMan 5.3 software.ResultsA total of 16 cohort studies involving 2 017 573 cases of single pregnancy were included. The results of meta-analysis showed that compared with the natural pregnancy group, the incidence of GDM was higher in the ART group (RR=1.54, 95%CI 1.30 to 1.83, P<0.000 01). In East Asia and Non-East Asia, the incidence of GDM in the ART group was higher than that in the natural pregnancy group (East Asia: RR=1.55, 95%CI 1.26 to 1.92, P<0.000 01; Non-East Asia: RR=1.49, 95%CI 1.18 to 1.89. P<0.000 1).ConclusionsCurrent evidence shows that the incidence of GDM may increase in single pregnancy with ART compared with natural pregnancy. Due to limited quantity and quality of the included studies, more high quality studies are required to verify above conclusions.