Endoscopic management of uterine myoma

This study was undertaken to evaluate the various gynecologic endoscopic surgical techniques including resectoscopic myomectomy, laparoscopic myomectomy, and laparoscopy assisted vaginal hysterectomy (LAVH) used in the treatment of uterine myomas. The medical records of 136 cases of uterine myomas treated using one or more of the gynecologic endoscopic surgical techniques in the Department of Obstetrics and Gynecology at Yonsei University were retrospectively reviewed from March 1997 to September 1998. Of the 136 cases reviewed, there were 40 submucosal myomas and 96 intramural and subserosal myomas. For statistical analysis, Student's t-test was used. Submucosal myomectomy using the resectosope was performed in 35 cases (mean age: 39 +/- 1.5 years), laparoscopic myomecotmy in 35 cases (mean age: 36 +/- 1.9 years), and LAVH in 66 cases (mean age: 42 +/- 1.1 years). In cases of huge myomas, the GnRH agonist was used prior to surgery, and in cases of heavy uterine bleeding, angioblock of the uterine artery was undertaken before the endoscopic procedures. The mean operating time was significantly shorter in resectoscopic myomectomy (41 +/- 12 min), followed by laparoscopic myomectomy (85.0 +/- 10.3 min) and LAVH (123 +/- 5.3 min). The mean hospital stay for resectoscopic myomectomy, laparoscopic myomectomy, and LAVH was 1.9 +/- 0.5, 2.5 +/- 0.5, and 3.4 +/- 0.8 days (p < 0.001), respectively. There were 3 cases of complications including pulmonary edema and uterine perforation in the resectoscopic myomectomy group, and 4 cases of complications including bladder, ureter, and epigastric vessel injury in the LAVH group. In conclusion, the therapeutic effect of various gynecologic endoscopic surgical techniques can be maximized in terms of shorter operation time, shorter hospital stay, faster recovery, and less blood loss by the appropriate management of uterine myoma in well-chosen patients.     

超声技术鉴别子宫肌瘤和子宫腺肌病

子宫肌瘤和腺肌病的准确鉴别在妇科临床诊治中有十分重要的意义,各种鉴别诊断技术中,超声技术因其无损性、简便性而成为常规的一种方法.超声成像技术是其中较为成熟的方法.在综述B型成像、彩色血流成像结合脉冲多普勒、彩色血流功率成像和三维彩色功率成像等四种超声成像技术鉴别子宫肌瘤和子宫腺肌病情况的基础上,介绍了两种新的超声鉴别方法:超声弹性检测技术、基于其他声学特征参数检测的组织定征技术.     

Clonal chromosome rearrangements in a uterine myoma

A cytogenetic study of a myoma of uterus with extensive hyaline, myxoid, and cystic degeneration revealed a clonal karyotype with a complex structural rearrangement involving chromosomes #3, #12, #14, #17, and #22. The modal chromosome number of the tumor was 45 due to monosomy #22. Analysis of seven additional myomas of the uterus including five tumors with typical histology and two with degenerative changes showed no clonal abnormalities. Single metaphases with a trisomy and a translocation were detected in two tumors. We conclude that although many uterine myomas appear to have normal karyotypes, clonal chromosome abnormalities are present in some of these tumors.     

Morphofunctional characteristics of the ovaries in proliferative uterine myoma

Morphofunctional changes in the ovaries in women of reproductive age with proliferative uterine myoma were studied. Disorders in folliculogenesis with primordial follicles degeneration of different degree, cystic degeneration of follicles at different stages of their development, paralleled by hyperplasia of the theca-granulosa complex and hyperestrogenemia, were detected. Morphological equivalent of hyperestrogenemia is increased content of lipid inclusions in granulosa cells, ultrastructural hyperplasia, increased volume and quantity of secretion-containing Cull-Exner bodies. __________ Translated from Byulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 141, No. 3, pp. 352–355, March, 2006     

子宫动脉栓塞治疗子宫肌瘤伴月经过多的临床研究

目的:回顾分析24例子宫肌瘤伴月经过多患者入介治疗疗效和子宫动脉栓塞安全性.方法:选择24例子宫肌瘤伴月经过多患者进行子宫肌瘤供血动脉的栓塞.结果:插管栓塞动脉率100%,随访2年.治疗后1月,24例患者月经均明显减少,B超随访,3个月子宫肌瘤体积平均缩小30%.随访2年,其中2例行腹腔镜下子宫肌瘤经阴道摘除术,6例子宫肌瘤消失,16例子宫肌瘤体积平均缩小80%.结论:子宫肌瘤行介入治疗疗效肯定,对粘膜下子宫肌瘤及子宫肌瘤伴月经过多患者尤为适宜.     

Changes in the human uterine vascular bed in myoma]

With scanning and transmission electron microscopy characteristic changes in the endothelial lining of myometrial vessels of uterus affected with myoma were revealed. In the presence of longitudinally oriented folds and microgrowths on the luminal surface in a healthy myometrial part, a number of changes were observed in the myoma vessels. These included the disappearance of cell surface derivatives, disturbance of tight junction of endothelial cells borders, the rise of cells over the endothelial monolayer and formation of crateriform pits. The partition of the endothelial cells on myoma vessels was accompanied by the disturbance of the microvesicular transendothelial transport.     

Treatment outcomes of uterine artery embolization and laparoscopic uterine artery ligation for uterine myoma

In treating women with leiomyoma and who wish to preserve their uterus, laparoscopic uterine artery ligation or uterine artery embolization should be considered as possible options. This study was performed to evaluate the efficacy of laparoscopic uterine artery ligation and uterine artery embolization in treating uterine myoma. The treatment outcomes of 23 patients who underwent uterine artery embolization and 17 laparoscopic uterine artery ligation were evaluated. The uterine volume reduced 3 months after uterine artery embolization, but thereafter no significant changes were observed. On the other hand, the uterine volumes were only slightly reduced 3 months after laparoscopic uterine artery ligation, and slightly more reduced 6 months later. The average reduction in the case of laparoscopic uterine artery ligation was about 58.5%. After laparoscopic uterine artery ligation, 20% of the patients complained of vaginal spotting. Furthermore, the mechanism of volume reduction was evaluated using specimens obtained from a biopsy taken after each procedure. The results suggested that laparoscopic uterine artery ligation results mainly in physiologic cell death, that is apoptosis, whereas, the corresponding result is cell necrosis for uterine artery embolization. Uterine artery embolization and laparoscopic uterine artery ligation are both effective in relieving the symptoms caused by uterine myoma, and therefore both procedures can be used in place of hysterectomy or myomectomy.     

Cytogenetic abnormalities in uterine myomas are associated with myoma size

Uterine leiomyomata (myomas) are associated with a variety of characteristic cytogenetic abnormalities. The significance of these chromosomal aberrations in the pathobiology of myomas remains to be determined. The present study investigated the relationship between myoma cytogenetic abnormalities and size. A total of 114 myoma specimens were obtained from 92 patients undergoing myomectomy or hysterectomy. The maximum diameter of each myoma was measured and a portion of each myoma obtained for cytogenetic analysis. Karyotypes were analysed and categorized as normal, abnormal (non-mosaic) or mosaic. Cytogenetic analyses revealed 73 (64%) normal, 20 (18%) abnormal (non-mosaic), and 21 (18%) mosaic karyotypes. Mean myoma diameter was 6.5+/-0.44 cm with a range of 0.4-27 cm. Differences between the mean myoma diameter of specimens with normal versus abnormal karyotypes was determined by the Kruskal-Wallis test. The mean myoma diameter among specimens with abnormal (non-mosaic) karyotypes was significantly greater than myomas with normal karyotypes (10.2+/- 5.9 versus 5.9+/-4.2 cm; P < 0.001). The proportion of abnormal (non- mosaic) karyotypes in myomas >6.5 cm was compared to myomas <6.5 cm by chi2-analysis; myomas >6.5 cm demonstrated a significantly higher proportion of abnormal (non-mosaic) karyotypes when compared to myomas <6.5 cm (75 versus 34%; P < 0.02). In summary, a significant relationship exists between clonal cytogenetic abnormalities and myoma size, suggesting that chromosomal abnormalities associated with individual myomas enhance myoma growth.      

Surgical treatment of uterine myoma (conservative myomectomy)]

As many as 56 patients with uterine myoma underwent conservative myomectomy. In 40 patients (group I), it was performed by laparotomy and in 16 (group II) ++trans-cervically under the control of hysteroscopy. The group I patients' age amounted on the average to 33.2 +/- 0.6 years, in group II, it was 46.3 +/- 0.8 years. Before operation the size of the uterus ranged from 6 to 32 weeks of pregnancy. Uterine incisions were made with regard to the site of myomatous nodes and the architectonics of the myometrium and vessels. To additionally strengthen++ sutures on the uterus, use was made of containing which provided for more favourable conditions for the formation of the scar on the uterus. Every second patient of the reproductive age manifested menstrual function improvement and 4 women conceived. The data obtained point out that the carrying out of conservative myomectomy is desirable in different age groups. The choice of the surgical technique is dependent on the primary site of myomatous nodes, their dimensions, the patient's age and concomitant extragenital pathology.