Gynecologie Obstetrique & Fertilite最新文献

英文中文

Prédictibilité préopératoire de la malignité des tumeurs ovariennes à partir du score ADNEX et utilisation en pratique clinique 卵巢肿瘤恶性肿瘤的术前预测及临床应用

Gynecologie Obstetrique & Fertilite

Pub Date : 2016-10-01 DOI: 10.1016/j.gyobfe.2016.07.007

E. Joyeux , T. Miras , I. Masquin , P.-E. Duglet , K. Astruc , S. Douvier

Objective

The principal aim of this study was the predictability of malignant ovarian tumors and to determine a cut-off value for this score to indicate the risk of malignancy that would be easy to use in clinical practice.

Methods

We retrospectively calculated the ADNEX score for all patients who underwent surgery for ovarian tumours in two Burgundy hospitals (Dijon University Hospital and Chalon-sur-Saône Hospital). We used the nine criteria of the ADNEX model. The inclusion criteria were the presence of all of the ADNEX criteria and a histology result. We analysed the sensitivity, specificity, PPV and PNV of four cut-offs (3%, 5%, 10% and 15%) for the entire pool then by age groups; from 14 to 42 (group 1) and 43 and more (group 2)

Results

Two hundred and eighty-four patients managed for an ovarian tumour were included between the 1st January 2013 and the 31st December 2015. Our AUC was of 0.94 (95% CI [0.903–0.977]) for discrimination between benign and malignant ovarian tumors. For a cut-off of 10%, sensitivity was 90%, specificity was 81.1%, PPV was 34.6% and PNV 98.5%. Results were lower for young women than for the second group. For a cut-off of 10%, group 1 had a sensitivity of 77.7% and specificity of 89.6%, PPV of 46.6% and PNV 97.5%. For the group 2, sensitivity was 95.2%, specificity was 76.6%, PPV was 33.8% and PNV was 99.2%. The most reasonable cut-off for the whole pool was 10%. For group 1 a cut-off of 5% was retained due to the less satisfying detection of “borderline” tumours more frequent in younger patients. For group 2 the cut-off of 10% gave the best results.

Conclusion

In our study, a lower cut-off for younger women seemed better suited to discriminate borderline tumours. In practice, the ADNEX score associated with the peroperative laparoscopic examination seems to be the best way to use the ADNEX model. Our study showed that the ADNEX model allows a good predictability of malignant ovarian tumours. The predictability becomes less satisfying for the youngest patients. A cut-off malignity value allowing surgical treatment of patients in a specialised facility was reached for two age groups: a cut-off of 5% for women under 42 years old and a cut-off of 10% for women over 43 years old.

目的本研究的主要目的是恶性卵巢肿瘤的可预测性，并确定该评分的临界值，以表明恶性肿瘤的风险，这将易于在临床实践中使用。方法回顾性计算所有在勃艮第两家医院(第戎大学医院和Chalon-sur-Saône医院)接受卵巢肿瘤手术的患者的ADNEX评分。我们使用了ADNEX模型的九个标准。纳入标准是所有ADNEX标准的存在和组织学结果。我们按年龄组分析了整个人群的敏感性、特异性、PPV和PNV的四个临界值(3%、5%、10%和15%);结果2013年1月1日至2015年12月31日共纳入卵巢肿瘤患者284例。鉴别卵巢良恶性肿瘤的AUC为0.94 (95% CI[0.903-0.977])。截止值为10%时，敏感性为90%，特异性为81.1%，PPV为34.6%，PNV为98.5%。年轻女性的结果低于第二组。对于10%的临界值，1组的敏感性为77.7%，特异性为89.6%，PPV为46.6%，PNV为97.5%。2组敏感性95.2%，特异性76.6%，PPV为33.8%，PNV为99.2%。整个池子最合理的临界值是10%。对于第1组，由于在年轻患者中更常见的“边缘”肿瘤的检测不太令人满意，因此保留了5%的截止值。对于第二组，10%的分界点给出了最好的结果。结论:在我们的研究中，年轻女性较低的临界值似乎更适合于鉴别交界性肿瘤。在实践中，ADNEX评分与术中腹腔镜检查相结合似乎是使用ADNEX模型的最佳方法。我们的研究表明，ADNEX模型可以很好地预测恶性卵巢肿瘤。对于最年轻的患者来说，这种可预测性就不那么令人满意了。两个年龄组达到了允许在专门机构对患者进行手术治疗的恶性肿瘤临界值:42岁以下妇女的临界值为5%，43岁以上妇女的临界值为10%。

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引用次数: 10

Hystérectomie et ganglion sentinelle en ambulatoire par voie robot-assistée : sommes-nous prêt en France ? 子宫切除术和哨兵淋巴结在移动机器人辅助:我们在法国准备好了吗?

Gynecologie Obstetrique & Fertilite

Pub Date : 2016-10-01 DOI: 10.1016/j.gyobfe.2016.08.017

J. Belghiti , E. Marchand , M. Nikpayam , G. Corsia , G. Canlorbe , C. Uzan

引用次数: 0

Gynecologie Obstetrique & Fertilite

Pub Date : 2016-10-01 DOI: 10.1016/j.gyobfe.2016.08.014

G. Kayem

引用次数: 0

Comment je fais… la mise en place d’un drain cannelé siliconé par voie cœlioscopique ? 我该怎么做…用腹腔镜方法安装硅槽引流?

Gynecologie Obstetrique & Fertilite

Pub Date : 2016-10-01 DOI: 10.1016/j.gyobfe.2016.08.010

P. Kadhel , D. Borja de Mozota

引用次数: 0

Gynecologie Obstetrique & Fertilite

Pub Date : 2016-10-01 DOI: 10.1016/j.gyobfe.2016.08.013

G. Kayem

引用次数: 0

In vitro fertilization outcomes after ablation of endometriomas using plasma energy: A retrospective case-control study 血浆能量消融子宫内膜瘤后的体外受精结果:一项回顾性病例对照研究

Gynecologie Obstetrique & Fertilite

Pub Date : 2016-10-01 DOI: 10.1016/j.gyobfe.2016.08.008

I. Motte , H. Roman , B. Clavier , F. Jumeau , I. Chanavaz-Lacheray , M. Letailleur , B. Darwish , N. Rives

Objective

Ovarian endometrioma ablation using plasma energy appears to be a valuable alternative to cystectomy, because it could spare underlying ovarian parenchyma resulting in high spontaneous and overall pregnancy rates. After initial postoperative decrease, anti-mullerian hormone (AMH) level progressively increases several months after ablation. The aim of our study was to assess the outcomes of in vitro fertilization (IVF) in women managed for ovarian endometriomas by ablation using plasma energy, when compared to those in women free of endometriosis.

Methods

Retrospective preliminary case-control study, enrolling women undergoing IVF or IntraCytoplasmic Sperm Injection (ICSI), from July 2009 to December 2014. Cases were infertile women with previous ovarian endometrioma ablation using plasma energy and were matched by age, AMH level and assisted reproductive technique with controls presumed free of endometriosis. IVF/ICSI response (type of protocol, dose of gonadotrophin, number of oocytes, fertilization rate) and outcomes were compared between the two groups.

Results

In all, 37 cases were compared to 74 controls. Age (30.9 ± 4.4 years vs. 31.7 ± 4.2 years), AMH level (2.8 ± 2 ng/mL vs. 2.8 ± 1.7 ng/mL) and ART procedures (ICSI in 24.3% vs. 27%) were comparable between the two groups. Of the 37 cases, previous surgical procedures on right and left ovaries were performed in 27% and 21.6% of patients respectively, 81% of patients were nullipara. AFSr score was 73 ± 41, while deep endometriosis infiltrated the rectum and the sigmoid colon in respectively 40.5% and 27% of patients. Despite a lower number of oocytes retrieved, cases presented better implantation rate, pregnancy and delivery rates per cycle, oocyte retrieval, transfer, and embryo, as well as superior cumulative birth rate per transfer.

Conclusion

Ovarian endometrioma ablation using plasma energy is followed by good IVF/ICSI outcomes, suggesting that surgical procedure spares underlying ovarian parenchyma. These results consolidate those of previous studies reporting high spontaneous conception rate. Hence, ovarian endometrioma ablation using plasma energy appears to be a valuable alternative to cystectomy in patients presenting with endometriosis and pregnancy intention.

目的:血浆能量切除卵巢子宫内膜瘤是一种有价值的替代膀胱切除术的方法，因为它可以避免潜在的卵巢实质，从而提高自然妊娠率和总妊娠率。术后最初下降后，抗苗勒管激素(AMH)水平在消融后几个月逐渐升高。本研究的目的是评估通过血浆能量消融治疗卵巢子宫内膜异位症的女性体外受精(IVF)的结果，并将其与无子宫内膜异位症的女性进行比较。方法回顾性初步病例对照研究，纳入2009年7月至2014年12月接受体外受精或卵胞浆内单精子注射(ICSI)的妇女。病例为既往使用血浆能量消融术治疗卵巢子宫内膜异位症的不孕妇女，与年龄、AMH水平和辅助生殖技术相匹配，对照组推定无子宫内膜异位症。比较两组的IVF/ICSI反应(方案类型、促性腺激素剂量、卵母细胞数、受精率)及结果。结果37例，对照组74例。年龄(30.9±4.4岁vs. 31.7±4.2岁)、AMH水平(2.8±2 ng/mL vs. 2.8±1.7 ng/mL)和ART程序(ICSI为24.3% vs. 27%)在两组之间具有可比性。37例患者中，分别有27%和21.6%的患者行过左、右卵巢手术，81%的患者无卵巢。AFSr评分为73±41，深部子宫内膜异位症浸润直肠和乙状结肠的比例分别为40.5%和27%。尽管取出的卵母细胞数量较少，但这些病例的着床率、每个周期的妊娠率和分娩率、卵母细胞取出率、移植率和胚胎率都较高，每次移植的累计出生率也较高。结论血浆能量切除卵巢子宫内膜瘤可获得良好的IVF/ICSI结果，提示手术可保护卵巢底层实质。这些结果巩固了先前报道高自然受孕率的研究。因此，对于有妊娠意向的子宫内膜异位症患者，血浆能量切除卵巢子宫内膜异位症似乎是一种有价值的替代膀胱切除术的方法。

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引用次数: 16

Dans quelle position les femmes accouchent-elles en 2015 ? Résultats d’une étude prospective régionale multicentrique 2015年女性分娩的位置是什么?多中心区域前瞻性研究的结果

Gynecologie Obstetrique & Fertilite

Pub Date : 2016-10-01 DOI: 10.1016/j.gyobfe.2016.06.010

D. Desseauve , B. Gachon , P. Bertherat , L. Fradet , P. Lacouture , F. Pierre

Objective

To assess the frequency of labor and birth positions in 2015, and identify factors associated with choosing and changing position during labor.

Methods

Multicenter prospective study during five weeks in 2015. We collected the distribution of the observed positions during the first and second stage of labor. Then we considered the main birth position as the one used for the longest duration. Factors associated to the main birth position as well as to the changes of position during labor were studied using univariate analysis and the role of each factor was analyzed using multilevel logistic regression.

Results

Among women who delivered, 86.1% did so in gynecological position. There was a center effect for the position during the expulsive phase, which was not related to legal status or level of perinatal care. After adjustment, a labor duration shorter than 2 hours was associated to dorsal decubitus during labor (OR = 2.1 95%CI [1.01–4.3]). Prematurity and labor duration less than 2 hours decreased the occurrence of changes in position during labor: OR = 0.05 95%CI [0.01–0.2] and OR = 0.2 95%CI [0.1–0.3]. Epidural analgesia was associated to change in birth position during labor: (OR = 2.1 95%CI [1.2–3.8]). During the expulsive phase, primiparity and labor duration less than 2 hours were associated to dorsal decubitus position (OR = 3.6 95%CI [1.2–10.8]).

Conclusion

Women still mostly deliver in gynecological position in 2015. A systematic collection of birth positions on the partograph, with an acute definition of these positions, could allow an evaluation of the benefits/disadvantages of the different positions currently available.

目的了解2015年产妇产程及分娩体位的发生频率，探讨产程中体位选择及变化的相关因素。方法2015年进行为期5周的多中心前瞻性研究。我们收集了第一和第二产程观察到的体位分布。然后我们将主要出生体位视为持续时间最长的体位。采用单因素分析研究分娩体位与分娩体位变化的相关因素，采用多水平logistic回归分析各因素的作用。结果86.1%的产妇在妇科体位分娩。排娩期体位存在中心效应，与法律地位和围产期护理水平无关。调整后，分娩时间短于2小时与分娩时背卧有关(OR = 2.1 95%CI[1.01-4.3])。早产和产程小于2小时降低产程体位变化的发生:OR = 0.05 95%CI[0.01-0.2]和OR = 0.2 95%CI[0.1-0.3]。分娩时硬膜外镇痛与分娩体位改变相关:(OR = 2.1 95%CI[1.2-3.8])。在排出期，初产和产程小于2小时与仰卧位有关(OR = 3.6 95%CI[1.2-10.8])。结论2015年产妇仍以妇科体位分娩为主。在产程上系统地收集出生体位，并对这些体位进行精确的定义，可以对目前可用的不同体位的利弊进行评估。

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引用次数: 4

Polémique sur la stérilisation tubaire 输卵管绝育争议

Gynecologie Obstetrique & Fertilite

Pub Date : 2016-10-01 DOI: 10.1016/j.gyobfe.2016.08.004

G. Chene , G. Lamblin

引用次数: 4

Quels signes échographiques doit-on rechercher (2D/3D) pour affirmer la bonne localisation des implants tubaires ? À propos d’une étude rétrospective de 92 cas 需要寻找哪些超声信号(2D/3D)来确定输卵管植入物的正确位置?关于92例回顾性研究

Gynecologie Obstetrique & Fertilite

Pub Date : 2016-10-01 DOI: 10.1016/j.gyobfe.2016.05.001

M. Simorre, P. Lopes, C. Le Vaillant

Objective

The aim of this study is to propose an analysis of the route and the curvature of the Essure^® system in 3D ultrasound to determine their correct location so as not to miss a tubal perforation.

Methods

This is a retrospective single center study during 2 years analyzing 92 3D ultrasound performed by a single sonographer. Implant placement was performed by different operators. One prescribed 3D ultrasound control in case of difficulties with the installation; other indications where systematics.

Results

The Essure^®’s position is right in 79% of cases. Twenty-eight implants appear incorrectly positioned on ultrasound 3D positioning. Abnormalities found are those described by the classification proposed in the literature. In one case, the curvature of the implant, not taking into account this classification, allowed to evoke a tubal perforation. Among the 28 cases of non-visualized implants in place, 3 cases of wrong position of the implant were confirmed by additional examinations (laparoscopy or HSG). For 14 cases, the ASP or HSG disproved the wrong position of the implants. In other cases, we did not have other complementary examinations.

Conclusion

Ultrasonography 3D seems to be the method of choice to control implants for simple implementation and good reproducibility. However, the interpretation of 3D ultrasound images is sometimes difficult. The study of the curvature of the implant should be systematically analyzed not to miss a tubal perforation.

目的本研究的目的是在三维超声中分析Essure®系统的路径和曲率，以确定其正确的位置，以免遗漏输卵管穿孔。方法回顾性分析2年来同一超声医师所做的92例三维超声。种植体放置由不同的操作人员进行。安装困难时，需提供一个指定的3D超声控制器;其他的迹象是系统的。结果在79%的病例中，Essure®的定位是正确的。28个植入物在超声3D定位中出现不正确的位置。发现的异常是文献中提出的分类所描述的异常。在一个病例中，种植体的曲率，没有考虑到这种分类，允许引起管穿孔。在28例未显像植入物就位的病例中，有3例植入物位置错误，经附加检查(腹腔镜或HSG)证实。在14例中，ASP或HSG证明了种植体的错误位置。在其他情况下，我们没有进行其他补充检查。结论三维超声检查具有操作简单、重复性好等优点，是控制种植体的首选方法。然而，三维超声图像的解释有时是困难的。对种植体曲率的研究应系统分析，以免遗漏输卵管穿孔。

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引用次数: 2

Comment je fais… une résection segmentaire urétérale par cœlioscopie 我怎么做腹腔镜输尿管节段切除术

Gynecologie Obstetrique & Fertilite

Pub Date : 2016-10-01 DOI: 10.1016/j.gyobfe.2016.08.007

C. Poupon, J. Niro, A. Le Tohic, P. Panel

引用次数: 0

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