Background Protecting female fertility stands as a central goal and vision in a fertility-friendly society, and fallopian tube recanalization offers the possibility of pregnancy for patients with tubal infertility. Objective This study aims to accurately identify the influencing factors affecting successful pregnancy after fallopian tube recanalization and explore the application of the random forest algorithm in screening and predicting pregnancy influencing factors in such patients. Methods The study collected and analyzed data from 170 patients who underwent laparoscopic combined with hysteroscopic fallopian tube recanalization at Capital Medical University Affiliated Beijing Shijitan Hospital between 2016 and 2018. Based on whether the patients achieved successful natural pregnancy within 2 years after the surgery, they were divided into the pregnancy and non-pregnancy groups. Using the R software, a random forest model for predicting pregnancy risk after tube recanalization was established on the training data set (108 cases, 63.2% of cases, extracted via Bootstrap method), and its prediction accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve (AUC) were evaluated on the verification data set. Results The study comprised 82 cases in the pregnancy group and 88 in the non-pregnancy group, with a spontaneous pregnancy rate of 48.2% post-surgery. The random forest algorithm, trained on the training set, demonstrated robust predictive capability upon validation, with an accuracy of 87.1%, sensitivity of 93.1%, specificity of 81.8%, positive predictive value of 81.8%, negative predictive value of 93.1%, and an AUC of 0.921. The random forest algorithm was employed to rank the importance of factors influencing pregnancy following fallopian tube recanalization by using variable importance scores. The analysis identified the top three significant predictor variables: duration of infertility, history of previous pregnancies, and patient age. Conclusion The random forest algorithm emerges as a viable tool for predicting factors influencing pregnancy after fallopian tube recanalization. The predictive model, predicated on infertility duration, history of prior pregnancies, and age, exhibits notable discrimination and accuracy. Early identification of key factors post-recanalization allows for timely and effective interventions. We recommend that patients presenting risk factors consider utilizing assisted reproductive technology to improve pregnancy rates.

目的 探讨慢性子宫内膜炎与输卵管通畅性的关系.方法 分析2015年6月至2019年12月在北京世纪坛医院因可疑输卵管性不孕同时接受腹腔镜和宫腔镜检查的育龄妇女363例,所有患者术中均进行宫腔镜检查并留取子宫内膜组织进行C跨膜硫酸已酰肝素蛋白聚糖合癸聚糖-1(CD138)的检测确定是否存在慢性子宫内膜炎,同时进行腹腔镜下输卵管的美兰通液,判断输卵管的通畅性,根据美兰通液的结果分为:输卵管通畅组与输卵管梗阻组.比较2组患者慢性子宫内膜炎的患病率.结果 输卵管梗阻组患者既往盆腔炎性疾病患病率要明显高于输卵管通畅组(52/177与22/186),且差异具有统计学意义(P=0.007).慢性子宫内膜炎在输卵管通畅组患病率为(22/186,11.8％),慢性子宫内膜炎在输卵管梗阻组患病率为(53/177,29.9％),2组相比差异具有统计学意义(P<0.01).双侧输卵管阻塞组经过输卵管疏通治疗后1个月行输卵管超声造影评价输卵管通畅性,9例(5.1％)提示双侧输卵管梗阻,其中3例受试者子宫内膜病理活检提示存在慢性子宫内膜炎.二元Logistic回归分析的结果表明:慢性子宫内膜炎是输卵管阻塞发生的高危因素[OR值(95％CI):3.388(1.831,6.269),P<0.05].结论 慢性子宫内膜炎是输卵管阻塞发生的危险因素,慢性子宫内膜炎的存在与双侧输卵管阻塞疏通术后患者的预后密切相关.

Objective To evaluate the efficacy of autologous platelet-rich fibrin (PRF) in the treatment of infertility due to intrauterine adhesion. Methods From October 2018 to October 2019, 40 patients diagnosed as intrauterine adhesion and excluded other infertility factors in Beijing Shijitan Hospital were randomly divided into PRF group and control group, with 20 cases in each group. The intervention lasted for 8 weeks. Patients in both groups underwent transcervical resection of adhesion (TCRA), and PRF was placed in the uterine cavity immediately after TCRA and 4 weeks later in the PRF group. After 8 weeks of TCRA, a second hysteroscopy was performed, and then follow-up was performed. Pregnancy rate, intrauterine adhesions score, menstruation, and endometrial thickness (EMT) were compared between two groups. Results The pregnancy rate of the PRF group was 70.00%, which was significantly higher than 20.00% of the control group (P 0.05). Conclusion The placement of PRF combined with the TCRA can improve the pregnancy rate of infertility due to intrauterine adhesion, reduce intrauterine adhesion scores, and improve clinical symptom.

目的 探讨经阴道四维超声子宫输卵管造影(4D-HyCoSy)诊断不孕症患者输卵管通畅性的应用价值.方法 回顾性对比分析112例不孕症患者经阴道4D-HyCoSy和腹腔镜亚甲蓝通液(LC)诊断输卵管通畅性的结果,计算4D-HyCoSy诊断输卵管阻塞的敏感度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比和AUC,并评价4D-HyCoSy与LC诊断输卵管通畅性的一致性.结果 112例不孕症患者共检查218条输卵管.以LC结果为金标准,4D-HyCoSy诊断输卵管通畅、通而不畅及阻塞的符合率分别为88.64％(39/44)、72.09％(62/86)、89.77％(79/88),总符合率为82.57％(180/218);4D-HyCoSy诊断输卵管阻塞的敏感度、特异度、阳性预测值、阴性预测值、阳性似然比及阴性似然比分别为80.61％(79/98)、92.50％(111/120)、89.77％(79/88)、85.38％(111/130)、10.75和0.19,AUC为0.87 (P＜0.01).4D-HyCoSy与LC诊断输卵管通畅性的一致性较好(Kappa=0.74).结论 4D-HyCoSy与LC诊断输卵管通畅性的一致性较好,4D-HyCoSy诊断输卵管阻塞具有较高的特异度.

Objective To evaluate the efficacy and safety of direct visualization cold-knife resection via hysteroscopy in the treatment of post-menopausal endometrial polyps.Methods From June 2014 to June 2016,89 patients with post-menopausal endometrial polyps were selected as research objects,and they were divided into observation group(45 cases)and control group(44 cases). Patients in the observation group were treated with direct visualization resection via hysteroscopy,while those in the control group were treated with blind polypectomy following diagnostic hysteroscopy.The operation duration,intraoperative bleeding volume, postoperative complications and recurrence rate of two groups were compared.Results Compared with the control group,the observation group had shorter operation duration,less bleeding volume and shorter postoperative hospital stay with statistically significant differences(t value was -9.18,-1.51 and -1.29,respectively,all P<0.05).There was 1 case of uterus perforation in the control group,but no intraoperative complications occurred in the observation group.Follow -up lasted for 6 to 24 months, during which no relapse in the observation group but 4 in the control group were found.Conclusion Direct visualization resection via hysteroscopy in the treatment of post-menopausal endometrial polyps is effective and safe.

目的比较应用于无痛人工流产术两种方法的效果。方法选择早孕妇女100例,随机均分为丙泊酚组(A组)和利多卡因局部麻醉组(B组)各50例。结果A组孕妇镇痛显效明显高于B组(P<0.05),A组RAAS发生率明显低于B组(P<0.01)。结论丙泊酚静脉麻醉用于无痛人工流产术简单、安全、有效。

Objective To explore diagnostic and monitoring treatment value of ovarian tumors by 18F-FDG-PET image.Methods 3 cases of ovarian tumors were confirmed by pathology. 40 minutes after intravenous administration of 18F-FDG ,PET scan was performed on them by using Siemens ECAT47 scanner,and at the same time the blood glucose of examinees should be controlled to that less than 6.7mmol/l.Results PET image showed a case of clear ovarian cell cancer with normal CA125, which could not be found by B ultrasonography . PET image could not only display local recurrence of lesion in a postoperative case with serious ovarian adenocarcinoma, but also metastases in the lung and mediastina. The PET image of a postoperative patient with endometrioid carcinoma of ovary was normal.Conclusion PET image, which is much more sensitive than any other methods, such as B ultrasonography ,tumor marker CA125, could be used to make a diagnosis of stage I ovarian cancer and monitor postoperative chemotherapy effect.

目的比较氨甲碟呤联合米非司酮与单用氨甲碟呤治疗异位妊娠的疗效.方法将临床确诊为异位妊娠39例分为A、B两组,A组19例为单一MTX治疗,肌注MTX 50 mg,每人3 d一次,共3次;B组20例为MTX联合米非司酮治疗,MTX的量及给药方法同A组,米非司酮的剂量为50 mg/d,连续3 d.βHCG下降至正常(正常值＜5 IU/L)为治愈,发生腹腔出血而手术治疗者为失败.对两组的成功率、成功病人的住院时间进行统计学处理.结果氨甲碟呤联合米非司酮治疗组20例,18例成功,成功率为90%.而单用氨甲碟呤治疗组19例,13例成功,成功率为64.8%.氨甲碟呤联合米非司酮治疗组的住院时间为25.3±4.8 d,而单用氨甲碟呤治疗组为29.8±3.7 d.经统计学检验,P＜0.05.结论联合治疗可以缩短住院时间,对于异位妊娠治疗有其使用价值.