Objective Female sterilization is a common contraceptive method,but with changing family dynamics,an increasing number of women seek to restore fertility after tubal sterilization.Current clinical practice lacks effec...Objective Female sterilization is a common contraceptive method,but with changing family dynamics,an increasing number of women seek to restore fertility after tubal sterilization.Current clinical practice lacks effective tools for predicting pregnancy rates in this population after tubal anastomosis.This study aims to develop and internally validate a novel nomogram for predicting the pregnancy rate in women with tubal ligation after tubal anastomosis.Methods We developed a prediction model based on a training dataset of 208 patients with tubal ligation after undergoing tubal anastomosis between January 2012 and August 2020 at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.The follow-up period for all patients was one year postsurgery,during which pregnancy outcomes were recorded.The LASSO regression model was used to optimize feature selection for the pregnancy rate risk model.The performance of the nomogram was assessed for its calibration,discrimination,and clinical usefulness.Internal validation was assessed.Results Predictors included in the prediction nomogram were age,type of anastomosis,sterilization duration,time of conception,and anti-Mullerian hormone(AMH)levels.The model displayed good discrimination,with a C-index of 0.924(95%CI:0.876–0.971),and good calibration.A high C-index value of 0.879 was still reached in the interval validation.Decision curve analysis revealed that the pregnancy rate nomogram was clinically useful when intervention was selected at the pregnancy rate possibility threshold of 1%.Conclusion This novel pregnancy rate nomogram incorporating age,type of anastomosis,sterilization duration,time of conception,and AMH could be conveniently used to predict the pregnancy rate in women with tubal ligation after tubal anastomosis.展开更多
Objective:Pelvic organ prolapse(POP)is a common gynecological disease in middle-aged and older women that seriously affects patients'physical health and quality of life,increases the financial burden for patients,...Objective:Pelvic organ prolapse(POP)is a common gynecological disease in middle-aged and older women that seriously affects patients'physical health and quality of life,increases the financial burden for patients,and becomes a major public health concern.The aim of this study was to investigate the medium-term outcomes of laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with a posterior approach for patients with severe POP.Methods:Patients with severe POP quantitation stage III-IV who underwent laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with a posterior approach at the Department of Obstetrics and Gynecology,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine between September 2016 and December 2020 were enrolled in this study.The results and complications were recorded.Data were retrospectively reviewed.Results:In total,124 patients were analyzed.Patients were followed up for 32.2712.90 months.The objective cure rate for patients who underwent hysterectomy was 917%(100/109),with 7(6.4%)patients had anterior vaginal wall prolapse and 2(1.8%)patients had posterior vaginal wall prolapse.The objective cure rate for patients who retained uterus was 66.7%(10/15).All 5 patients with recurrence had uterine prolapse,and 3(20.0%)of them also had anterior vaginal wall prolapse.Conchusions:Laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with the posterior approach is a safe,minimally invasive,and effective method for patients with severe POP.Long-term follow-up is needed to confirm the clinical effects.展开更多
基金supported by the Zhejiang Provincial Health Science and Technology Project Fund (2024KY227).
文摘Objective Female sterilization is a common contraceptive method,but with changing family dynamics,an increasing number of women seek to restore fertility after tubal sterilization.Current clinical practice lacks effective tools for predicting pregnancy rates in this population after tubal anastomosis.This study aims to develop and internally validate a novel nomogram for predicting the pregnancy rate in women with tubal ligation after tubal anastomosis.Methods We developed a prediction model based on a training dataset of 208 patients with tubal ligation after undergoing tubal anastomosis between January 2012 and August 2020 at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.The follow-up period for all patients was one year postsurgery,during which pregnancy outcomes were recorded.The LASSO regression model was used to optimize feature selection for the pregnancy rate risk model.The performance of the nomogram was assessed for its calibration,discrimination,and clinical usefulness.Internal validation was assessed.Results Predictors included in the prediction nomogram were age,type of anastomosis,sterilization duration,time of conception,and anti-Mullerian hormone(AMH)levels.The model displayed good discrimination,with a C-index of 0.924(95%CI:0.876–0.971),and good calibration.A high C-index value of 0.879 was still reached in the interval validation.Decision curve analysis revealed that the pregnancy rate nomogram was clinically useful when intervention was selected at the pregnancy rate possibility threshold of 1%.Conclusion This novel pregnancy rate nomogram incorporating age,type of anastomosis,sterilization duration,time of conception,and AMH could be conveniently used to predict the pregnancy rate in women with tubal ligation after tubal anastomosis.
基金supported by the National Key Research and Development Program of China(2018YFC1004800)the Scien-tific Research Fund of Zhejiang Provincial Education Department(Y2020433-40)。
文摘Objective:Pelvic organ prolapse(POP)is a common gynecological disease in middle-aged and older women that seriously affects patients'physical health and quality of life,increases the financial burden for patients,and becomes a major public health concern.The aim of this study was to investigate the medium-term outcomes of laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with a posterior approach for patients with severe POP.Methods:Patients with severe POP quantitation stage III-IV who underwent laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with a posterior approach at the Department of Obstetrics and Gynecology,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine between September 2016 and December 2020 were enrolled in this study.The results and complications were recorded.Data were retrospectively reviewed.Results:In total,124 patients were analyzed.Patients were followed up for 32.2712.90 months.The objective cure rate for patients who underwent hysterectomy was 917%(100/109),with 7(6.4%)patients had anterior vaginal wall prolapse and 2(1.8%)patients had posterior vaginal wall prolapse.The objective cure rate for patients who retained uterus was 66.7%(10/15).All 5 patients with recurrence had uterine prolapse,and 3(20.0%)of them also had anterior vaginal wall prolapse.Conchusions:Laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with the posterior approach is a safe,minimally invasive,and effective method for patients with severe POP.Long-term follow-up is needed to confirm the clinical effects.
