Objectives Conventional approaches for removal of lateral skull base tumors, including transmandibular, infratemporal fossa, preauricular transzygmatic subtemporal approaches, are major invasive procedures that often ...Objectives Conventional approaches for removal of lateral skull base tumors, including transmandibular, infratemporal fossa, preauricular transzygmatic subtemporal approaches, are major invasive procedures that often sacrifice hearing and cause abnormal occlusion and cosmetic defects. Reports of the transcervical approach for resection of skull base tumors are rare, although it was described for resection of clival chordomas in as early as 1966. The purpose of this study is to review our experiences in management of lateral skull base tumors using the transcervical approach. Study Design Retrospective chart review. Methods Six lateral skull base tumor cases treated with transcervical approach procedures were reviewed, including the medical records. Results There were 4 males and 2 females. Age ranged from 12 through 52 years. Histopathological diagnoses included malignant schwannoma(n = 1), malignant carotid body tumor(n = 1), heamangioma(n=1), schwannoma (n=2) and pleomorphic adenoma (n = 1). Transcervical techniques were used in all cases with the use of microscope in the lateral skull base area. Complete tumor removal was achieved in all cases. Postoperative radiotherapy was implemented in 1 case of malignant schwannoma and 1 case of malignant carotid body tumor. Jugular foramen syndrome occurred as a surgical complication in 1 case of malignant Schwannoma of the vagus nerve. There was no tumor recurrence during the 10 - 42 month follow-up period. Conclusion Compared with conventional approaches, the transcervical approach provides a easy, safe, minimal invasive and effective procedure for removal of selected lateral skull base tumors.展开更多
Objective: To compare labor induction with transcervical catheter to oral misoprostol treatment in primiparous women and women with an unripe cervix, who are at high risk for unsuccessful labor induction. Study Design...Objective: To compare labor induction with transcervical catheter to oral misoprostol treatment in primiparous women and women with an unripe cervix, who are at high risk for unsuccessful labor induction. Study Design: A retrospective study was carried out in a university hospital in Sweden. Primary outcomes were vaginal birth within 24 hours and the cesarean section rate. Secondary outcomes were the induction to vaginal delivery interval, chorioamnionitis and neonatal asphyxia. Results: Vaginal birth within 24 hours was obtained more frequently after catheter compared with misoprostol in primiparous women (p < 0.001) and women with Bishop scores 3 - 4 (p < 0.001), but not in women with Bishop scores 0 - 2 (p = 0.07). The cesarean section rates were comparable in all groups (p > 0.05). The induction to vaginal delivery interval was 8 - 12 hours shorter after catheter (p < 0.001). The rates of chorioamnionitis and newborns with an Apgar score 0.05). Conclusion: Labor induction with transcervical catheter resulted in a higher rate of vaginal birth within 24 hours and an 8 - 12 hour shorter induction to vaginal delivery interval compared to treatment with oral misoprostol. This was obtained without increasing the rates of cesarean section, chorioamnionitis or neonatal asphyxia.展开更多
Transcervical approach for tumors of the posterior mediastinum is traditionally thought not to be indicated. Hereby we report on a case of a patient with a huge neurogenic tumor of the posterior mediastinum which was ...Transcervical approach for tumors of the posterior mediastinum is traditionally thought not to be indicated. Hereby we report on a case of a patient with a huge neurogenic tumor of the posterior mediastinum which was successfully excised through a transcervical extended approach and, additionally, the variety of surgical approaches used to remove tumors of the posterior mediastinum is discussed. The new refined techniques of transcervical extended mediastinal operations, which are recently gaining popularity among surgeons, allowed for a safe dissection of the tumor, thus patient could benefit from a short painless postoperative course. The authors suggest that surgeons trained in these particular techniques should consider the choice of the transcervical extended access in selected cases of benign tumors of the posterior mediastinum.展开更多
Objectives: To investigate the clinical effects of transcervical interstitial microwave irradiation of adenomyotic tissues as an alternative to hysterectomy. Methods: Thirty-three patients who were candidates for hyst...Objectives: To investigate the clinical effects of transcervical interstitial microwave irradiation of adenomyotic tissues as an alternative to hysterectomy. Methods: Thirty-three patients who were candidates for hysterectomy for the treatment of adenomyosis associated with menorrhagia were treated by interstitial microwave irradiation using a specifically developed transabdominal ultrasound probe attachment for transcervical puncture along with microwave endometrial ablation, as an alternative to hysterectomy. Primary outcomes were changes in the venous hemoglobin level and the volume of the uterine body before and after treatment. Secondary outcomes were the visual-analogue scale (VAS) score for menorrhagia and dysmenorrhea after treatment. Results: At 3 months after surgery, the average hemoglobin level significantly increased by 4.6 g/dL. The volume of the uterine body significantly decreased to 53% and 52% of the volume before treatment at 3 and 12 months, respectively. VAS scores indicated an improvement in menorrhagia and dysmenorrhea. Conclusions: Transcervical interstitial microwave ablation therapy combined with microwave endometrial ablation reduced the uterine body volume and relieved menorrhagia and dysmenorrheal caused by adenomyosis. This strategy is a promising alternative to hysterectomy for the treatment of symptomatic adenomyosis.展开更多
Background： The pregnancy outcome of the unicornuate uterus is associated with an increased risk of miscarriage, cervical incompetence, and a number of obstetric complications. However, at present, there is no accept...Background： The pregnancy outcome of the unicornuate uterus is associated with an increased risk of miscarriage, cervical incompetence, and a number of obstetric complications. However, at present, there is no accepted treatment method for women with unicornuate uterus, other than expectant measures. The aim of this study was to evaluate the reproductive outcome of transcervical uterine incision （TCUI） in patients with unicornuate uterus. Methods： Thirty-three patients with unicoruuate uterus presented to our tertiary center tbr infertility or miscarriage. All 33 patients underwent TCUI and were followed up for 10-52 months. The pregnancy outcomes （first-trimester miscarriage, second-trimester miscarriage, preterm, term, intrauterine death, ongoing pregnancy, and live birth） before and after TCUI were compared by t-test. Results： Among 31 patients who attempted to conceive alter TCUI, twenty conceived including one terufination of pregnancy, one second-trimester miscarriage, one ectopic pregnancy, five preterm deliveries, 11 term delivery, and one ongoing pregnancy. There were 16 live births in total. There was significant reduction in the first-trimester miscarriage rate （t = 4.890; P 〈 0.001 ）, increase in term delivery （t = -3.288; P =0.002）, and live birth rates （t = -4.073; P 〈 0.001 ） after TCUI. Conclusion： TCUI appeared to improve the pregnancy outcome in women with unicoruuate uterus presenting with infertility or miscarriage.展开更多
在内腔镜手术,包括经尿道前列腺电切术（transurethral resection of the prostate,TURP）、经宫颈子宫内膜切除术（transcervical resection of the endometrium,TCRE）、经皮肾镜取石术（percutaneous nephrolithotripsy,PCNL）等手术...在内腔镜手术,包括经尿道前列腺电切术（transurethral resection of the prostate,TURP）、经宫颈子宫内膜切除术（transcervical resection of the endometrium,TCRE）、经皮肾镜取石术（percutaneous nephrolithotripsy,PCNL）等手术中,为保持手术操作视野的清晰,及时冲洗掉手术中切除的组织、残渣或血液,需要使用大量的冲洗液以一定的速度及压力进行冲洗。展开更多
子宫肌瘤是妇科最常见的良性肿瘤,子宫肌瘤合并妊娠占肌瘤患者的0.5%-1%,占妊娠者的0.3%-0.5%,黏膜下子宫肌瘤占肌瘤总数10%-15%。宫腔镜下子宫肌瘤电切术（transcervical resection of myoma,TCRM）是目前解决黏膜下肌瘤的较为理想的...子宫肌瘤是妇科最常见的良性肿瘤,子宫肌瘤合并妊娠占肌瘤患者的0.5%-1%,占妊娠者的0.3%-0.5%,黏膜下子宫肌瘤占肌瘤总数10%-15%。宫腔镜下子宫肌瘤电切术（transcervical resection of myoma,TCRM）是目前解决黏膜下肌瘤的较为理想的方法。本研究就黏膜下子宫肌瘤行TCRM术后对妊娠的影响进行临床分析。展开更多
Atypical polypoid adenomyoma (APAM) is a rare polypoid tumor that generally occurs in women of reproductive age who have abnormal genital bleeding. The tumor was reported as a new disease concept by Mazur in 1981. Pat...Atypical polypoid adenomyoma (APAM) is a rare polypoid tumor that generally occurs in women of reproductive age who have abnormal genital bleeding. The tumor was reported as a new disease concept by Mazur in 1981. Pathologically, APAM consist of irregularly proliferated endometrial gland cells and interlacing bundles of smooth muscle cells within the stroma, and have a similar form to adenocarcinoma, adenofibroma, adenosarcoma, and carcinosarcoma. Therefore, differential diagnosis is required in many cases. APAM is pathologically classified as a benign lesion and clinically has a comparatively favorable outcome. However, treatment and follow-up observation should be performed carefully because recurrence and residual lesions occur in many patients after conservative treatment. Concomitant development of endometrial adenocarcinoma also occurs in many cases and it is difficult to differentiate this disease from APAM. Thus, diagnosis of APAM should be made carefully, particularly since the number of cases of endometrial adenocarcinoma has increased in recent years. Furthermore, APAM tends to develop during a woman’s reproductive years, and fertility sparing treatment should be considered. Here, we review the clinicopathological characteristics of APAM, including the difficulty of diagnosis as a benign or malignant uterine tumor, and we examine the relationship between APAM and endometrial cancer.展开更多
Transcervical resection of adhesion(TCRA)is the standard treatment for the intrauterine adhesions,but the recurrence of adhesions is a tough problem for the gynecologist.In addition,the therapeutic strategy after TCRA...Transcervical resection of adhesion(TCRA)is the standard treatment for the intrauterine adhesions,but the recurrence of adhesions is a tough problem for the gynecologist.In addition,the therapeutic strategy after TCRA about prevention of recurrence remains controversial especially for the patients with moderate to severe intrauterine adhesions(IUAs).Hence,we designed this study to explore the safety and efficacy of fresh amnion grafts for preventing the recurrence after TCRA for patients with moderate to severe IUAs.One hundred patients with moderate to severe IUAs who presented with a history of hypomenorrhea,amenorrhea and infertility were included in the study from January 2015 to December 2017.Patients were divided into amnion group(52 patients)and chitosan group(48 patients).Fresh amnion grafts or intrauterine injections of chitosan were administered after TCRA.Transvaginal ultrasonography(TVUS)and hysteroscopy were performed at the first and third month after the operation.The surgical procedures for all patients were completed successfully without relevant complications.In amnion group,8 patients exhibited relapse in the first month and 2 patients in three months after surgery;in chitosan group,23 women exhibited relapse in the first month and 18 patients in three months after surgery.Statistical analysis revealed that the recurrence rate of adhesion in amnion group was significantly lower than those of chitosan group in the first and three months after surgery(P1=0.000,P2=0.000).After TCRA,fresh amnion graft plays a significant role in preventing further adhesions than injections of chitosan.展开更多
文摘Objectives Conventional approaches for removal of lateral skull base tumors, including transmandibular, infratemporal fossa, preauricular transzygmatic subtemporal approaches, are major invasive procedures that often sacrifice hearing and cause abnormal occlusion and cosmetic defects. Reports of the transcervical approach for resection of skull base tumors are rare, although it was described for resection of clival chordomas in as early as 1966. The purpose of this study is to review our experiences in management of lateral skull base tumors using the transcervical approach. Study Design Retrospective chart review. Methods Six lateral skull base tumor cases treated with transcervical approach procedures were reviewed, including the medical records. Results There were 4 males and 2 females. Age ranged from 12 through 52 years. Histopathological diagnoses included malignant schwannoma(n = 1), malignant carotid body tumor(n = 1), heamangioma(n=1), schwannoma (n=2) and pleomorphic adenoma (n = 1). Transcervical techniques were used in all cases with the use of microscope in the lateral skull base area. Complete tumor removal was achieved in all cases. Postoperative radiotherapy was implemented in 1 case of malignant schwannoma and 1 case of malignant carotid body tumor. Jugular foramen syndrome occurred as a surgical complication in 1 case of malignant Schwannoma of the vagus nerve. There was no tumor recurrence during the 10 - 42 month follow-up period. Conclusion Compared with conventional approaches, the transcervical approach provides a easy, safe, minimal invasive and effective procedure for removal of selected lateral skull base tumors.
文摘Objective: To compare labor induction with transcervical catheter to oral misoprostol treatment in primiparous women and women with an unripe cervix, who are at high risk for unsuccessful labor induction. Study Design: A retrospective study was carried out in a university hospital in Sweden. Primary outcomes were vaginal birth within 24 hours and the cesarean section rate. Secondary outcomes were the induction to vaginal delivery interval, chorioamnionitis and neonatal asphyxia. Results: Vaginal birth within 24 hours was obtained more frequently after catheter compared with misoprostol in primiparous women (p < 0.001) and women with Bishop scores 3 - 4 (p < 0.001), but not in women with Bishop scores 0 - 2 (p = 0.07). The cesarean section rates were comparable in all groups (p > 0.05). The induction to vaginal delivery interval was 8 - 12 hours shorter after catheter (p < 0.001). The rates of chorioamnionitis and newborns with an Apgar score 0.05). Conclusion: Labor induction with transcervical catheter resulted in a higher rate of vaginal birth within 24 hours and an 8 - 12 hour shorter induction to vaginal delivery interval compared to treatment with oral misoprostol. This was obtained without increasing the rates of cesarean section, chorioamnionitis or neonatal asphyxia.
文摘Transcervical approach for tumors of the posterior mediastinum is traditionally thought not to be indicated. Hereby we report on a case of a patient with a huge neurogenic tumor of the posterior mediastinum which was successfully excised through a transcervical extended approach and, additionally, the variety of surgical approaches used to remove tumors of the posterior mediastinum is discussed. The new refined techniques of transcervical extended mediastinal operations, which are recently gaining popularity among surgeons, allowed for a safe dissection of the tumor, thus patient could benefit from a short painless postoperative course. The authors suggest that surgeons trained in these particular techniques should consider the choice of the transcervical extended access in selected cases of benign tumors of the posterior mediastinum.
文摘Objectives: To investigate the clinical effects of transcervical interstitial microwave irradiation of adenomyotic tissues as an alternative to hysterectomy. Methods: Thirty-three patients who were candidates for hysterectomy for the treatment of adenomyosis associated with menorrhagia were treated by interstitial microwave irradiation using a specifically developed transabdominal ultrasound probe attachment for transcervical puncture along with microwave endometrial ablation, as an alternative to hysterectomy. Primary outcomes were changes in the venous hemoglobin level and the volume of the uterine body before and after treatment. Secondary outcomes were the visual-analogue scale (VAS) score for menorrhagia and dysmenorrhea after treatment. Results: At 3 months after surgery, the average hemoglobin level significantly increased by 4.6 g/dL. The volume of the uterine body significantly decreased to 53% and 52% of the volume before treatment at 3 and 12 months, respectively. VAS scores indicated an improvement in menorrhagia and dysmenorrhea. Conclusions: Transcervical interstitial microwave ablation therapy combined with microwave endometrial ablation reduced the uterine body volume and relieved menorrhagia and dysmenorrheal caused by adenomyosis. This strategy is a promising alternative to hysterectomy for the treatment of symptomatic adenomyosis.
文摘Background： The pregnancy outcome of the unicornuate uterus is associated with an increased risk of miscarriage, cervical incompetence, and a number of obstetric complications. However, at present, there is no accepted treatment method for women with unicornuate uterus, other than expectant measures. The aim of this study was to evaluate the reproductive outcome of transcervical uterine incision （TCUI） in patients with unicornuate uterus. Methods： Thirty-three patients with unicoruuate uterus presented to our tertiary center tbr infertility or miscarriage. All 33 patients underwent TCUI and were followed up for 10-52 months. The pregnancy outcomes （first-trimester miscarriage, second-trimester miscarriage, preterm, term, intrauterine death, ongoing pregnancy, and live birth） before and after TCUI were compared by t-test. Results： Among 31 patients who attempted to conceive alter TCUI, twenty conceived including one terufination of pregnancy, one second-trimester miscarriage, one ectopic pregnancy, five preterm deliveries, 11 term delivery, and one ongoing pregnancy. There were 16 live births in total. There was significant reduction in the first-trimester miscarriage rate （t = 4.890; P 〈 0.001 ）, increase in term delivery （t = -3.288; P =0.002）, and live birth rates （t = -4.073; P 〈 0.001 ） after TCUI. Conclusion： TCUI appeared to improve the pregnancy outcome in women with unicoruuate uterus presenting with infertility or miscarriage.
文摘在内腔镜手术,包括经尿道前列腺电切术（transurethral resection of the prostate,TURP）、经宫颈子宫内膜切除术（transcervical resection of the endometrium,TCRE）、经皮肾镜取石术（percutaneous nephrolithotripsy,PCNL）等手术中,为保持手术操作视野的清晰,及时冲洗掉手术中切除的组织、残渣或血液,需要使用大量的冲洗液以一定的速度及压力进行冲洗。
文摘子宫肌瘤是妇科最常见的良性肿瘤,子宫肌瘤合并妊娠占肌瘤患者的0.5%-1%,占妊娠者的0.3%-0.5%,黏膜下子宫肌瘤占肌瘤总数10%-15%。宫腔镜下子宫肌瘤电切术（transcervical resection of myoma,TCRM）是目前解决黏膜下肌瘤的较为理想的方法。本研究就黏膜下子宫肌瘤行TCRM术后对妊娠的影响进行临床分析。
文摘Atypical polypoid adenomyoma (APAM) is a rare polypoid tumor that generally occurs in women of reproductive age who have abnormal genital bleeding. The tumor was reported as a new disease concept by Mazur in 1981. Pathologically, APAM consist of irregularly proliferated endometrial gland cells and interlacing bundles of smooth muscle cells within the stroma, and have a similar form to adenocarcinoma, adenofibroma, adenosarcoma, and carcinosarcoma. Therefore, differential diagnosis is required in many cases. APAM is pathologically classified as a benign lesion and clinically has a comparatively favorable outcome. However, treatment and follow-up observation should be performed carefully because recurrence and residual lesions occur in many patients after conservative treatment. Concomitant development of endometrial adenocarcinoma also occurs in many cases and it is difficult to differentiate this disease from APAM. Thus, diagnosis of APAM should be made carefully, particularly since the number of cases of endometrial adenocarcinoma has increased in recent years. Furthermore, APAM tends to develop during a woman’s reproductive years, and fertility sparing treatment should be considered. Here, we review the clinicopathological characteristics of APAM, including the difficulty of diagnosis as a benign or malignant uterine tumor, and we examine the relationship between APAM and endometrial cancer.
基金we appreciate Shanbi Zhou for providing the way about how to prepare the fresh amnion.And the study was funded by the Medical Research Project of Chongqing(NO.20141014)the Medical Characteristic Professional Subjects Construction Project of Chongqing(NO.2013-46).
文摘Transcervical resection of adhesion(TCRA)is the standard treatment for the intrauterine adhesions,but the recurrence of adhesions is a tough problem for the gynecologist.In addition,the therapeutic strategy after TCRA about prevention of recurrence remains controversial especially for the patients with moderate to severe intrauterine adhesions(IUAs).Hence,we designed this study to explore the safety and efficacy of fresh amnion grafts for preventing the recurrence after TCRA for patients with moderate to severe IUAs.One hundred patients with moderate to severe IUAs who presented with a history of hypomenorrhea,amenorrhea and infertility were included in the study from January 2015 to December 2017.Patients were divided into amnion group(52 patients)and chitosan group(48 patients).Fresh amnion grafts or intrauterine injections of chitosan were administered after TCRA.Transvaginal ultrasonography(TVUS)and hysteroscopy were performed at the first and third month after the operation.The surgical procedures for all patients were completed successfully without relevant complications.In amnion group,8 patients exhibited relapse in the first month and 2 patients in three months after surgery;in chitosan group,23 women exhibited relapse in the first month and 18 patients in three months after surgery.Statistical analysis revealed that the recurrence rate of adhesion in amnion group was significantly lower than those of chitosan group in the first and three months after surgery(P1=0.000,P2=0.000).After TCRA,fresh amnion graft plays a significant role in preventing further adhesions than injections of chitosan.
