uterine myomas

  • 文章类型: Journal Article
    背景:法国国家妇产科学院(CNGOF)在2016年的最新报告中给出了关于妇科超声最低标准的法国指南。准确的报告对于妇女的最佳护理至关重要,尤其是那些出现肌瘤的。这项研究的目的是评估0至2型子宫肌瘤女性的妇科超声报告质量,参考法国准则中的项目。
    方法:对某医院的私人办公室和妇科的超声检查报告进行了一项回顾性描述性研究,2014年6月至2016年6月(CNGOF报告之前)。这些报告涉及接受宫腔镜子宫肌瘤切除术的妇女。对所有报告进行了验证项目的搜索,并分析了丢失的物品。还通过卡方检验比较了不同类型的从业者以及医院和私人医疗机构之间的差异。
    结果:共分析了138份报告;71份在私人办公室进行,67份在医院妇科进行。报告中丢失了许多物品,机构类型(私人办公室或医院)和从业人员专业(放射科医生或妇科医生)之间存在差异。关于肌瘤的具体项目,例如国际妇科医生和妇产科医师联合会(FIGO)对后壁进行分类或测量,在放射科医生的报告中更常见(89.7%和79.5%,分别)比妇科医生的报告(21.2%和34.3%,分别)(P<0.05)。在私人办公室报告和医院报告之间,这些数据也存在显着差异。与超声结构相关的项目,如肌瘤或相关的腹部积液的出现,在妇科医生的报告中更常见(88.9%和49.5%,分别)与放射科医生的报告(56.4%和12.8%,分别)(P<0.05)。
    结论:所有报告中都有某些项目,而其他人没有得到充分的提及。这些不平等可以部分由实践的类型来解释;然而,必须开发克服这些困难的方法。放射科医生和妇科医生联合开展的宣传运动,对专业人员进行最低限度的报告和培训,可能会改善报告并改善对妇女的护理。
    BACKGROUND: French guidelines regarding the minimum criteria for gynaecological ultrasound were given in a recent report in 2016, by the French National College of Obstetricians and Gynaecologists (CNGOF). An accurate report is essential for the optimal care of women, especially those presenting myomas. The goal of this study was to evaluate the quality of gynaecological ultrasound reports for women with type 0 to 2 uterine myomas, referring to the items contained in the French guidelines.
    METHODS: A retrospective descriptive study was conducted from reports of ultrasounds performed in private offices and in the gynaecologic department of a hospital, between June 2014 and June 2016 (before the report of CNGOF). These reports involved women who underwent hysteroscopic resection of myoma(s). A search of validated items was conducted for all of the reports, and the missing items were analysed. The different types of practitioners and between hospital and private medical offices were also compared with Chi-square tests.
    RESULTS: A total of 138 reports were analysed; 71 were performed in private offices and 67 were performed in the gynaecologic unit of the hospital. Many items were missing in the reports, with disparities between the type of institution (private offices or hospital) and the speciality of practitioners (radiologists or gynaecologists). Specific items regarding myomas, such as the International Federation of Gynaecologists and Obstetricians (FIGO) classification or measurement of the posterior wall, were more often missing in reports from radiologists (89.7% and 79.5%, respectively) than in reports from gynaecologists (21.2% and 34.3%, respectively) (P<0.05). A significant difference was also observed for these data between private offices\' reports and hospitals\' reports. Items relative to ultrasound structures, such as the appearance of myomas or associated abdominal effusion, were more frequently missing in gynaecologists\' reports (88.9% and 49.5%, respectively) compared to radiologists\' reports (56.4% and 12.8%, respectively) (P<0.05).
    CONCLUSIONS: Certain items are present in all the reports, while others are insufficiently mentioned. These inequalities can be explained in part by the type of practice; however, methods to overcome these difficulties must be developed. Information campaigns to educate professionals on the minimum reporting and training conducted jointly by radiologists and gynaecologist surgeons might improve reports and improve the care of women.
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  • 文章类型: Journal Article
    Background: Official guideline \"indications and methods of hysterectomy\" to assign indications for the different methods published and coordinated by the German Society of Gynecology and Obstetrics (DGGG), the Austrian Society of Gynecology and Obstetrics (OEGGG) and the Swiss Society of Gynecology and Obstetrics (SGGG). Besides vaginal and abdominal hysterectomy, three additional techniques have been implemented due to the introduction of laparoscopy. Organ-sparing alternatives were also integrated. Methods: The guideline group consisted of 26 experts from Germany, Austria and Switzerland. Recommendations were developed using a structured consensus process and independent moderation. A systematic literature search and quality appraisal of benefits and harms of the therapeutic alternatives for symptomatic fibroids, dysfunctional bleeding and adenomyosis was done through MEDLINE up to 6/2014 focusing on systematic reviews and meta-analysis. Results: All types of hysterectomy led in studies to high rates of patient satisfaction. If possible, vaginal instead of abdominal hysterectomy should preferably be done. If a vaginal hysterectomy is not feasible, the possibility of a laparoscopic hysterectomy should be considered. An abdominal hysterectomy should only be done with a special indication. Organ-sparing interventions also led to high patient satisfaction rates, but contain the risk of symptom recurrence. Conclusion: As an aim, patients should be enabled to choose that therapeutic intervention for their benign disease of the uterus that convenes best to them and their personal life situation.
    Hintergrund: Offizielle Leitlinie, publiziert und koordiniert von der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG), der Österreichischen Gesellschaft für Gynäkologie und Geburtshilfe (OEGGG) und der Schweizerischen Gesellschaft für Gynäkologie und Geburtshilfe (SGGG). Durch die Einführung laparoskopischer Operationen wurde die vaginale und abdominale Hysterektomie um 3 weitere Techniken ergänzt. Um die Indikationsfelder abzugrenzen, wurde die Leitlinie „Indikation und Methodik der Hysterektomie bei benignen Erkrankungen“ initiiert. Organerhaltende Therapiealternativen wurden ebenfalls integriert. Methode: Die Leitlinie wurde durch ein repräsentatives Gremium von 26 Experten aus Deutschland, Österreich und der Schweiz unter strukturierter unabhängiger Moderation im Konsens erstellt. Die systematische Literatursuche und -bewertung zu Nutzen und Schaden der Therapiealternativen bei symptomatischem Uterus myomatosus, funktionellen Blutungsstörungen und Adenomyosis sowie ein Vergleich der Hysterektomieverfahren erfolgte bis 06/2014 in der Datenbank MEDLINE mit Fokus auf aggregierter Evidenz. Ergebnisse: Alle Formen der Hysterektomie sind in Studien mit einer hohen Zufriedenheit der Patientinnen verbunden. Der vaginalen Hysterektomie soll gegenüber der abdominellen, wenn möglich, der Vorzug gegeben werden. Ist die vaginale Hysterektomie nicht möglich, sollte die Möglichkeit einer laparoskopischen Hysterektomie geprüft werden. Die abdominale Hysterektomie sollte nur bei gesonderter Indikation durchgeführt werden. Für die organerhaltenden Alternativen wurde ebenfalls ein hoher Zufriedenheitsgrad festgestellt, allerdings können bei Belassen des Uterus Rezidive auftreten. Schlussfolgerung: Ziel der Aufklärung ist, die Patientin in die Lage zu versetzen, unter den Therapieoptionen für benigne Uteruserkrankungen diejenige herauszufinden, die am besten zu ihr und ihrer Lebenssituation passt.
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