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En-lan Xia

Publications and source records attributed to En-lan Xia.

12 recordsLinked to original sources
PubMed2005

[Transcervical resection of myoma in treatment of hysteromyoma, experience in 962 x\cases].

OBJECTIVE: To study the technique and effect of transcervical resection of myoma (TCRM) in treatment of hysteromyoma. METHODS: 962 women suffering type 0 hysteromyoma (n = 281), 316 type 1 hysteromyoma (n = 316), type 2 hysteromyoma (n = 282), submucous and intramural myoma (n = 34), cervical myoma (n = 11), prolapse myoma (n = 23), and adenomyoma (n = 15) underwent TCRM with "five-step technique", monitored by B-ultrasound or laparoscopy, Follow-up lasted more than 6 months. RESULTS: The primary operation successful rate was 99.77%. The mean size and depth of uterus were 7.44 +/- 1.3 gestation weeks and (8.31 +/- 1.43) cm, the diameter of the biggest myoma was 7.2 cm. The mean weight of the resected tissues was (22.63 +/- 31.41) g, and the mean operation time and blood loss during the operation were 32.50 +/- 172.72 minutes and (7.75 +/- 19.49) ml. No transfusion was needed. The complications included postoperative fever (3 cases), uterine bleeding (1 case), uterine perforation (1 case), and TURP syndrome (2 cases). Postoperative scanty menstrual rate was 100% in the type 0 hysteromyoma group, 99.1% in the type I hysteromyoma group, 94.02% in the type II hysteromyoma group, 100% in the cervical myoma and prolapse myoma group, 84% in the multiple myoma and intramural myoma group, and 87% in the adenomyoma group respectively. The alleviation rates of dysmenorrhea and anemia were 78% and 82.95% respectively. Those who have severe complications of internal medicine showed obvious improvement. The residual myoma of 2 cases were resected during the secondary operation 9 days and 3 months after the primary operation. 455 cases (52.17%) resumed their work in 1 month postoperatively. 32 living infants were delivered. CONCLUSION: Safe and highly effective, TCRM can be the first choice in treatment of submucous and intramural hysteromyoma.

Adult↗
PubMed2005

[Analysis on the complications of hysteroscopic surgeries].

OBJECTIVE: To investigate the causations, management and prevention methods on the complications of hysteroscopic procedures. METHODS: Retrospective analysis of 36 cases with hysteroscopic complication, focusing on their characteristics and clinical management as well as prevention methods during the ten years from 1993 to 2004. RESULTS: Among 36 cases, 11 cases with uterine perforation and incomplete perforation, which happened during the complicated procedures, were treated by both laparoscopy and laparotomy. Five cases with heavy bleeding were encountered because of the deeply injury to the uterine wall and Foley catheter was inserted into uterine cavity and it stopped the bleeding successfully except in one case done by hysterectomy. Three cases with fluid overload syndrome were cured by using diuretic agent and saline infusion. There is no serious consequence in one case with air embolism due to prompt diagnosis and treatment. Four cases with postablation-sterilization syndrome were treated effectively by performing hysterectomy plus single or bilateral salpingectomy, dilating cervical canal as well as resecting adhesions. Twelve cases with adhesion inside uterine cavity followed hysteroscopy were also treated by dilating cervical canal, underwent adhesionlysis and hysterectomy. CONCLUSIONS: The potential factors causing complications of hysteroscopy include complicated procedures inside uterine cavity, higher pressure of irrigation, deep injury of endometrium as well as incomplete removal of endometrium during hysteroscopic operations. It is the necessary measures to reduce the complications by performing laparoscopy or B ultrasound monitoring simultaneously, standardizing the procedure and strengthening postoperation management.

Endometrium↗
PubMed2005

[Study on mechanism of infertility or sterility caused by uterine septa and reproductive prognosis after hysteroscopic metroplasty].

OBJECTIVE: To study the mechanism of infertility/sterility caused by uterine septa and the reproductive prognosis after transcervical resection of septum (TCRS). METHODS: One hundred and eleven patients with uterine septum including 34 patients of infertility and 77 patients of sterility were performed on TCRS. The patients were followed up of the reproductive outcomes. The process of pregnancies and deliveries were compared with those of 1548 normal uterine pregnancies. We also studied and compared the pathomorphologic and the micro-structure features between the septum and uterine wall in 30 cases (8 cases with infertility and 22 cases with sterility). RESULTS: (1) The amount of the endometrium glands on septum was less than that on the uterine wall or endometrium un-synchronous growth between septum and uterine wall was shown in 7 cases of infertility and 13 cases of sterility. The positive index level of estrogen and progestogen receptors on septum was weaker than that on uterine wall. The densities of the smooth muscle cells were thicker and the collagenous fibers were sparser in the base and middle of septum compared with uterine wall (P < 0.05). The amounts of the small arteries in septum were rarer than in uterine wall (P < 0.05). Ultrastructure characters showed glandular epithelium cells distributed irregularly and poor pili on septum in the sterility patients. (2) Sixteen infertility patients became pregnant (47.1%, 16/34) postoperation, which was much higher than pregnancy rate of preoperation (8.8%, 3/34, P < 0.01). In sterility group, the spontaneous abortion rate decreased from 84.1% (180/214) to 29.0% (18/62, P < 0.01), and the mature delivery rate and live birth rate rose from 3.3% (7/214), 0.9% (2/214) to 56.4% (35/62) and 64.5% (40/62) respectively (P < 0.01). (3) There were no differences between TCRS patients and normal uterine pregnant women in complications, and the mortality of perinatal (P > 0.05). The rate of cesarean section in post-TCRS patients was higher than in normal control group (P < 0.01). CONCLUSIONS: The differences of pathomorphology and ultra-structure between septum and uterine wall are the causation of infertility/sterility in the uterine septum patients. The reproductive prognosis can be improved remarkably by performing TCRS, which does not increase pregnant complications or affect fetus growth. Cesarean section should not be a standard way for delivery.

Adult↗
PubMed2004

[Evaluation on clinical application and long term outcomes of transcervical resection of endometrium].

OBJECTIVE: To evaluate the short term and long term outcomes of abnormal uterine bleeding (AUB) treated by transcervical resection of endometrium (TCRE) as well as the factors which influence the outcomes. METHODS: From May 1990 to September 2002 there were 1431 cases who suffered from menorrhagia. A total of 1468 times of TCRE were performed. Hysteroscopic diagnosis and endometrium biopsy was performed to rule out malignant diseases in 1203 cases. One stage TCRE was performed in 265 cases. Resistance index (RI) and pulse index (PI) of every level uterine artery were measured by ultrasound and serum levels of were 6 steroid sex hormones were measured by laboratory in 32 cases. The mean duration of follow-up was 68.5 months (3 - 148 months). RESULTS: Three cases of uterine perforation were encountered. Smog like echo in the anterior uterine wall was found in 714 cases (49.9%) by B ultrasonography, among them 21 cases (63.6%) were proved adenomyosis by pathological examination. One hundred and fifty nine cases (10.8%) had been treated by drugs, such as homeostasis, analgesic agent, antibiotics, progesterone and endometrium inhibiting agents, etc. Repeat TCRE was performed in 37 cases. Owing to recurrent bleeding, dysmenorrhea or uterine myoma 87 cases (6.1%) were finally received hysterectomy. CONCLUSIONS: (1) The main cause of recurrence was incomplete destruction of or leak from basal layer of endometrium. Shift wire loop with the sheath together to resect endometrium from the fundus to cervix smoothly can solve the problem of incomplete resection. Upon completion of operations, "blind area" and "blind point" should be examined and resected again if there is some endometrium left behind which could solve leak from basal layer of endometrium. (2) The duration of follow-up and adenomyosis are the main factors, which influence the long-term successful rate. (3) TCRE dose not influence the ovarian function obviously.

Adolescent↗
PubMed2004

[Analysis of the efficiency of transcervical resection of endometrium for treating dysfunctional uterine bleeding and factors reducing the efficiency of the operation].

OBJECTIVE: To investigate the efficiency and factors related to the recurrence of transcervical resection of endometrium (TCRE) in treating women with dysfunctional uterine bleeding (DUB). METHODS: Two hundred and twenty women with DUB were selected for TCRE. Specimens from removed endometrium were obtained during the procedures and their menstruation and menorrhagia after the operations were followed up. We also studied the uterine specimens obtained from the recurrent cases undergoing hysterectomies. The specimens were stained by hematoxylin-eosin and immuno-histochemistry respectively to evaluate the depth of removed myometrium and the histopathologic changes in relapsed cases. RESULTS: The follow up period after operation was 24 to 114 months. (1) Overall effective rate was 94.5%, in which amenorrhea rate was 25.9%, menstruation reduction rate was 68.6%. (2) The effective rate of corrective anemia was 97.3% and the satisfaction rate for the operation was 92.3%. (3) Thirty-eight cases required subsequent treatment as a result of recurrence, of which 10 cases underwent hysterectomy and 3 cases underwent repeat TCRE and 25 cases were given medicine treatment. (4) The average depth of myometrium in removed endometrium strip was 2.12 approximately 3.26 mm. (5) Endometrium regrowth was seen in the resected uterine specimens from relapsed cases and adenomyosis was also found in the intra-uterine wall in some cases. CONCLUSIONS: (1) TCRE is a safe and effective alternative treatment for DUB. (2) The main factor reducing the efficiency is either incomplete removal of endometrium or adenomyosis. (3) Standardizing the procedures and strengthening postoperative management are essential requirements for improving the efficiency of TCRE.

Adult↗
PubMed2003

[Analysis of 16 cases of uterine perforation during hysteroscopic electro-surgeries].

OBJECTIVE: To analyse the cause, diagnosis, treatment and preventive methods of uterine perforation resulting from hysteroscopic electro-surgeries. METHODS: Data of cases with uterine perforation were collected from 5 hospitals where overall 3,541 hysteroscopic electro-surgeries were done from May 1990 to July 2002. There were 1 468 transcervical resections of endometrium (TCRE), 797 cases of transcervical resection of myoma (TCRM), 783 cases of transcervical resection of endometrial polyp (TCRP), 189 cases of transcervical resection of uterine septa (TCRS), 112 cases of transcervical resection of uterine adhesion (TCRA) and 192 cases of transcervical removal of foreign body (TCRF). All operations were performed under B-ultrasonographic or laparoscopic monitoring. Cervical dilator stick was inserted into cervical canal or 200 micro g of misoprostol put in the posterior fornix the evening before operation. The procedures were done according to different indications and purposes. Cases of uterine perforation were divided into two groups: caused by approaching (entry-related) and by surgical instruments (technique-related). RESULTS: Totally sixteen cases (0.45%) of uterine perforation occurred. Seven cases occurred during cervical dilatation and 1 during hysteroscopy inserting lentry-related. Eight cases were technique-related caused by electrode. The incidences of uterine perforation of different operations were: TCRA 4.46% (5/112), TCRF 3.12% (6/192), TCRE 0.27% (4/1 468), TCRM 0.13% (1/797). TCRP and TCRS none. These 16 cases were all diagnosed during operations. 10 cases (62%) by B ultrasound and (or) laparoscopy, 6 cases (38%) by hysteroscopy and clinical features. 13 cases were complete uterine perforations, among them 2 were diagnosed by laparoscopic monitoring, 5 by B-ultrasonic monitoring, 4 by hysteroscopy and 2 by symptoms and B-ultrasound, 3 cases were incomplete uterine perforations in which 2 were diagnosed by laparoscopic monitoring and one by B-ultrasound monitoring. CONCLUSIONS: Half of uterine perforation cases were entry-related, so attention has to be paid to entry of Hegar or hysteroscopy (i.e., not dilate the cervix as possible and introduce the scope under direct vision). The other half were related to surgeons' experience and type of operation. TCRA and TCRF run more risks. B-ultrasound and (or) laparoscopy monitoring during hysteroscopic electro-surgery may help to prevent but not completely avoid uterine perforation.

Adult↗
PubMed2003

[Research on repairing patterns and factors causing subsequent surgery after trancervical resection of endometrium].

OBJECTIVE: To study the repairing process and the factors causing subsequent surgery after trancervical resection of endomitrium (TCRE). METHODS: From March 1991 to September 2002, 1 431 hysteroscopic endometrium resection procedures were performed in Hysteroscopic Center of Fuxing Hospital, and 38 patients who required additional treatment which include 13 hysterectomy, 3 repeat TCRE and 22 uterine curettage were collected and the specimens were stained by hemaloxylin-eosin, Masson's trichrome and respiratory enzyme dehydronicotinamide adenine dinucleotide phosphate diaphorase as well as proliferative cell nuclear antigen (PCNA) respectively to evaluate the tissue healing process and the histopathological changes. Some of the changes were observed by electron microscope. RESULTS: (1) The superficial myometrium presented necroses and granulationingitis in the early stage and then scar formation in the later stage followed TCRE. (2) The granulation structure was covered with columnar epithelial cell and the smouth muscle cell regrowth which showed positive reaction by PCNA staining below the scarred tissue. (3) The undestroyed glands of endometrial floor were showed both inside granulation and scar tissue where lymphocytes infiltration and a great deal of foreign-body giant cells were also found. Focal and diffuse endometrium regeneration located beside these granulation and scar structure. (4) Adenomyosis presented in some of uterine specimens, but the cycle endometrium and inflammatory granulation tissue presented in the uterine curettage tissue. CONCLUSIONS: The repairing patterns of destroyed myometrium are mainly based on granulationingitis and scar formation followed TCRE procedure, endometrial glands and smooth muscle cells regrowth are also involved in this process. Endometrium regeneration, adenomyosis and inflammation are the main reasons caused subsequent surgery.

Adult↗