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1.
Background
Conventionally, myomectomy during cesarean section is reserved only for pedunculated myomas because resection of myomas at the time of cesarean section usually stimulates profuse bleeding.Cases
Thirty-one patients underwent myomectomy using purse-string suture during cesarean section. Myoma could be excised without profuse bleeding, while an assistant maintains strong tension on the purse-string suture around the myoma. The suture was tightened and tied immediately after complete resection of the myoma and then stitches of another purse-string suture were placed alternately with each previous stitch in the inner side of the first suture. We have used this method for more than 3 years and have not observed failures and serious complications, such as late hemorrhage and uterine rupture during a subsequent pregnancy.Conclusion
Myomectomy using purse-string suture during cesarean section is a safe, useful, and convenient technique.2.
Sergio Haimovich Gemma Mancebo Francesc Alameda Silvia Agramunt Josep M. Solé-Sedeno José Luis Hernández Ramón Carreras 《European journal of obstetrics, gynecology, and reproductive biology》2013
Objective
To assess the feasibility of a new two-step technique for office hysteroscopic resection of submucous myomas.Study design
Between January 2010 and December 2011, all consecutive patients of reproductive age with symptomatic lesions sonographically diagnosed as single mainly intracavitary (G1 or G2) myoma ≤4.0 cm were eligible to participate in a prospective study. They underwent a two-step hysteroscopic procedure, which included preparation of partially intramural myomas with incision of the endometrial mucosa and the pseudocapsule covering the myoma in the first step, and excision of the myoma by means of diode laser four weeks later. All procedures were performed on an outpatient basis and without anesthesia.Results
A total of 43 women (mean age 36.7 years) were included. The two-step myomectomy technique was successfully performed in 34 (79.1%) patients. All myomas ≤18 mm were successfully enucleated as compared with 85% of 19–30 mm, and 0% of ≥30 mm (P < 0.001). Also, myomas located in the anterior/posterior walls and those located in the fundus/lateral walls were enucleated in 87.9% and 50% of cases, respectively (P = 0.020). Success of surgery was not influenced by the initial type of myoma.Conclusion
The new two-step hysteroscopic myomectomy carried out as an outpatient procedure and without anesthesia is feasible for the excision of symptomatic submucous fibroids. 相似文献3.
Results of hysteroscopic myomectomy 总被引：6，自引：0，他引：6
Cravello L Agostini A Beerli M Roger V Bretelle F Blanc B 《Gynécologie, obstétrique & fertilité》2004,32(9):825-828
Main symptoms related to submucous fibroids are menorrhagia, infertility, and postmenopausal bleeding. First experiences of hysteroscopic transcervical resection of fibroids have been published by Neuwirth in the late seventies. Reports with long-term follow-up in patients with abnormal uterine bleeding are available. After a follow-up period of five years and more, results are satisfactory in 70-85% of the patients. Intramural class 2 and larger fibroids (> 4 cm) constitute the limits of the endoscopic technique. Prior to hysteroscopic myoma resection, pretreatment with GnRH agonists may be indicated in selected cases (large myomas, patients suffering from secondary anemia). Repeat resection is an option after failed primary hysteroscopic operation and may reduce the hysterectomy rate. In infertile women with submucosal or intracavitary fibroids, pregnancy and delivery rates are increased after hysteroscopic myomectomy. Operative hysteroscopy is also safe and effective in controlling persistent postmenopausal bleeding. To conclude, hysteroscopic resection is the gold standard for the treatment of symptomatic submucous fibroids. 相似文献
4.
Amanda G. Cooke Timothy L. McCavit George R. Buchanan Jacquelyn M. Powers 《Journal of pediatric and adolescent gynecology》2017,30(2):247-250
Study Objective
To assess the clinical severity and initial treatment of iron deficiency anemia (IDA) in female adolescents with heavy menstrual bleeding (HMB) in our center.Design
Retrospective cohort study of electronic medical records via search of administrative records using International Classification of Diseases Ninth Revision codes for IDA or unspecified anemia and disorders of menstruation.Setting
Children's Medical Center in Dallas, Texas.Participants
One hundred seven patients with HMB and concomitant IDA (median age, 14.4 years) who presented to the outpatient, emergency department, and/or inpatient settings.Results
The median initial hemoglobin concentration for all patients (n = 107) was 7.4 g/dL, and most (74%, n = 79) presented to the emergency department or via inpatient transfer. Symptomatic IDA was treated with blood transfusion in 46 (43%, n = 46). Ferrous sulfate was the most commonly prescribed oral iron therapy. Seven patients received intravenous iron therapy either initially or after oral iron treatment failure. Combined oral contraceptives were commonly prescribed for abnormal uterine bleeding, yet 10% of patients (n = 11) received no hormonal therapy during their initial management. Evaluation for underlying bleeding disorders was inconsistent.Conclusion
Severe anemia because of IDA and HMB resulting in urgent medical care, including hospitalization and blood transfusion, is a common but underemphasized problem in adolescent girls. In addition to prevention and early diagnosis, meaningful efforts to improve initial management of adolescents with severe HMB and IDA are necessary. 相似文献5.
Szu-Yu Chen Bor-Ching Sheu Su-Cheng Huang Wen-Chun Chang 《Taiwanese journal of obstetrics & gynecology》2017,56(4):467-471
Objective
To report a single surgeon's experience with 109 laparoendoscopic single-site myomectomy (LESS-M) using conventional laparoscopic instruments and a homemade glove port system.Materials and methods
A total of 109 consecutive women who underwent LESS-M between March 2011 and April 2015 were reviewed.Results
The mean age and body mass index were 38.3 ± 6.5 years and 22.1 ± 3.0 kg/m2. The mean diameter of the largest myoma and the mean number of myomas were 8.1 ± 2.4 cm and 1.6 ± 0.7. The mean weight of the myomas was 223.2 ± 159.7 g. The most common type of myoma was intramural (61%), followed by subserosal (23%), submucosal (9%), and intraligamental (7%). The most common site of the myomas was anterior (39%), followed by posterior (38%), lateral (15%), and fundal (9%). The mean operative time and estimated blood loss were 138.5 ± 43.8 min and 104.9 ± 270.1 mL. Two patients (1.8%) required intraoperative transfusion. The mean hospital stay was 2.5 ± 0.6days. There were no conversions to laparotomy, but three patients(2.8%) were converted to two-port laparoscopic myomectomy. No patient experienced any major complication, including bowel, ureter, bladder injuries, or incisional hernia. Six women became pregnant after the operation, and five of these patients delivered their babies at full term by cesarean section. One patient delivered her baby at a gestational age at 32 weeks due to idiopathic polyhydramnios by cesarean section. One patient had the second pregnancy and delivery after LESS-M. Fourteen patients (12.8%) had small recurrent myomas that did not require treatment.Conclusion
LESS-M is a feasible alternative for patients with symptomatic myomas, and this technique can provide cosmetic advantages compared to conventional laparoscopic surgery. 相似文献6.
7.
Yael Pecchioli Lamide Oyewumi Lisa M. Allen Sari Kives 《Journal of pediatric and adolescent gynecology》2017,30(2):239-242
Study Objective
Despite the fact that most cases of abnormal uterine bleeding (AUB) in adolescence are due to an immature hypothalamic-pituitary-ovarian (HPO) axis, the current approach to investigating adolescents who present with AUB often includes pelvic ultrasound to exclude rare structural causes. The aim of this study was to determine whether an ultrasound ordered for the investigation of AUB in adolescents detects any significant anatomic pathology or alters diagnosis and management.Design, Setting, Participants, and Interventions
A retrospective chart review of 230 patients younger than 18 years of age who presented with AUB to the gynecology clinic at the Hospital for Sick Children in Toronto, Canada between January 2010 and December 2012 was completed.Main Outcome Measures
Findings on pelvic ultrasound and any further imaging as well as management choices for these patients were examined.Results
Of all patients, 67.8% (156/230) had ultrasound done as part of their AUB workup. The most common diagnosis for the patients who received ultrasound examinations and the patients who did not was AUB due to an immature HPO axis. Of the patients who received an ultrasound examination, 72.4% (113/156) had normal findings; incidental findings were identified in 17.9% (28/156) and polycystic ovary syndrome morphology in 6.4% (10/156). Structural causes of AUB were found in only 2 (1.3%) of the adolescents imaged. No patient had a change in her AUB management plan because of ultrasound findings.Conclusion
Our results strongly suggest that pelvic ultrasound examination is not required in the initial investigation of AUB in the adolescent population because it did not alter treatment in any of our patients. 相似文献8.
Takeda A Imoto S Mori M Yamada J Nakamura H 《European journal of obstetrics, gynecology, and reproductive biology》2012,160(1):88-92
Objective
To report our initial experience with isobaric (gasless) two-port laparoscopic-assisted myomectomy (LAM) in 40 patients with symptomatic myoma at a single center.Study design
In each case, wound retractors were used as working ports through umbilical and suprapubic mini-incisions. The surgical view was secured with the subcutaneous abdominal wall-lift method. Surgical procedures were performed using conventional laparoscopic and laparotomic instruments under vision with a rigid 30-degree, 5-mm EndoEYE laparoscope. Clinical data regarding patient demographics and surgical outcomes were retrospectively analyzed.Results
Between November 2010 and May 2011, forty patients with symptomatic myomas were treated with isobaric two-port LAM. Cases consisted of 24 intramural, 13 subserosal and 3 submucosal myomas in various locations. The median surgical duration was 86 (range, 38-160) min with median blood loss of 50 (range, 10-670) mL. Median number and weight of excised myoma nodes were 2.5 (range, 1-30) and 130.5 (range, 4-712) g, respectively. Neither additional incisions nor laparotomic conversion were required in any cases. Although major surgical complications were not experienced in the present case series, extended hospitalization was required in 4 cases (10%) due to elevated inflammatory parameters. Delayed dehiscence of the suprapubic incision was noted in 1 case and was conservatively managed. After the umbilical incision was concealed within the umbilical fold and the suprapubic incision was hidden in the pubic hair, all patients were satisfied with their cosmetic results.Conclusions
Isobaric two-port LAM performed by a combined approach through umbilical and suprapubic mini-incisions with hidden scar is a useful minimally invasive measure for management of symptomatic uterine myomas under various conditions. 相似文献9.
Cheng-Yu Ho Kok-Min Seow Lee-Wen Huang Yieh-Loong Tsai 《Taiwanese journal of obstetrics & gynecology》2017,56(6):831-835
Objective
Acquired uterine arteriovenous malformation (UAVM) is a rare, life-threatening disease. Angiography with uterine arterial embolization (UAE) is the diagnostic tool and a choice of fertility-sparing treatment. Here, we present a series of five successful pregnancies after embolization of UAVM.Case reports
Three reproductive aged women were treated for UAVM, resulting in five successful pregnancies. Their past history suggested that three cases had had previous uterine procedures, including second trimester abortion and elective dilatation and curettage. Intermittent heavy vaginal bleeding was the primary symptom of UAVM. One patient with anemia had two ineffective embolizations and achieved a singleton pregnancy after the third embolization. However, intrauterine fetal demise with severe fetal growth retardation was noted on the 28th gestation week. The other two women had temporary ovulation disorder after UAE. After Clomiphene Citrate (CC) treatment, successful pregnancies were achieved and carried to term uneventfully.Conclusion
UAE is an acceptable method for preserving fertility and treatment in women with symptomatic UAVMs. 相似文献10.
Tasneem S. Alaqzam Angela C. Stanley Pippa M. Simpson Veronica H. Flood Seema Menon 《Journal of pediatric and adolescent gynecology》2018,31(5):451-458
Study Objective
On this study we sought to determine the relationship of bleeding disorders to iron deficiency anemia. Additionally, this study was undertaken to examine all current treatment modalities used in a menorrhagia clinic with respect to heavy menstrual bleeding management to identify the most effective options for menstrual management in the setting of an underlying bleeding disorder.Design, Setting, Participants, Interventions, and Main Outcome Measures
We performed a retrospective chart review of adolescents younger than 21 years with heavy menstrual bleeding attending a multidisciplinary hematology-adolescent gynecology clinic. Information including demographic characteristics, bleeding diathesis, hematologic parameters, treatment, and the diagnosis was extracted from each chart. Subjects were grouped into 2 categories on the basis of the diagnosis of a bleeding disorder. Hemoglobin level, iron deficiency anemia, and need for transfusion were compared between a bleeding disorder and no bleeding disorder group. Subjects were grouped into categories depending on hormonal modality and treatment success of the groups were compared.Results
Seventy-three subjects were tested for a bleeding disorder. Of the subjects who completed testing, 34 (46%) were diagnosed with a bleeding disorder. Thirty-nine subjects (54%) had heavy menstrual bleeding because of other causes. There was no significant difference in hemoglobin between those with and without a bleeding disorder. Iron deficiency anemia was significantly higher in subjects without a bleeding disorder. In a comparison of hormone therapy success, the levonorgestrel intrauterine device (89%, 8 out of 9 subjects) had the highest rate of menstrual suppression followed by norethindrone acetate 5-10 mg/d (83%, 5 out of 6 subjects), and the transdermal patch (80%, 4 out of 5 subjects). All subjects using tranexamic acid as well as hormonal therapy had 100% achievement of menstrual suppression.Conclusion
A high frequency of bleeding disorders was found in those tested. Subjects with a bleeding disorder were less likely to present with severe anemia requiring blood transfusion and less likely to have iron deficiency anemia. Although combined oral contraceptives were commonly used clinically for menstrual suppression, they were not found to be the most effective option. 相似文献11.
Purpose of the Study
To assess the efficacy of hysteroscopy in diagnosis of AUB.Method
A total of 56 women in reproductive and peri-menopausal age group (20–50 years) with complaints of abnormal uterine bleeding were enrolled in the study. All the patients underwent hysteroscopic examination followed by biopsy/histopathological evaluation. Hysteroscopic findings were compared against histopathological findings. Sensitivity, specificity, PPV, NPV and accuracy of hysteroscopy were calculated.Results
Mean age of patients was 36.4 ± 7.6. Majority (60.7%) presented within 6 months of complaints. Clinically, 66.1% were diagnosed as menorrhagia, 30.4% polymenorrhoea and 3.6% intermenstrual bleeding. Hysteroscopically 53.6% presented with abnormal pathology, it diagnosed polyps in 16.1%, calcification in 12.5%, submucous fibroma in 10.7%, necrotic mass in 7.1%, adhesion and forgotten IUCD in 5.4% cases each. However, on histopathology, 33 (58.9%) cases had normal/proliferative/atrophic endometrium, 12 (21.4%) had hyperplasia, 7 (12.5%) had calcified endometrium, and 12 (21.4%) had polyp. No significant difference between two modalities was observed with respect to number of normal/proliferative/atrophic endometrium (p = 0.185). Histopathology diagnosed hyperplasia in significantly higher proportion of patients as compared to hysteroscopy (p = 0.042). Hysteroscopy diagnosed significantly higher proportion of patients with submucous myoma (p = 0.012) and necrotic mass (p = 0.042). Statistically, no significant difference between two modalities was observed with respect to other pathologies (p > 0.05). Overall agreement between two modalities was 62.5%. For pathological abnormalities in general, hysteroscopy had sensitivity, specificity, PPV, NPV and accuracy values of 78.3, 63.6, 60, 80.8 and 69.6%, respectively.Conclusion
Hysteroscopy provided additional information for some of the pathologies, otherwise remaining undiagnosed by HPE.12.
Deidre Meulenbroeks Tjalina W.O. Hamerlynck Sema Saglam-Kara Nadia K. Van Rijssel Huib A.A.M. Van Vliet Benedictus C. Schoot 《Journal of minimally invasive gynecology》2017,24(1):159-164
Study Objective
To compare polyp resection time and myoma resection rate using 2 hysteroscopic tissue removal systems.Design
Prospective randomized in vitro trial (Canadian Task Force classification I).Setting
Clinical skills laboratory of a non-university teaching hospital.Samples
Polyp surrogate and myoma tissue.Interventions
Hysteroscopic tissue removal with the TRUCLEAR system, using the TRUCLEAR INCISOR 2.9 (TI), TRUCLEAR INCISOR Plus (TIP), or TRUCLEAR ULTRA Plus (TUP) device, and the MyoSure system, using the MyoSure Lite (ML), MyoSure Classic (MC), or MyoSure XL (MXL) device.Measurements and Main Results
Forty-two fragments of umbilical cord weighing 5 g, as a surrogate for polyps, were randomly allocated to 4 types of devices (TI, TIP, ML, and MC). Three consecutive fragments were removed using a single device. In addition, 18 pieces of myoma tissue were divided into 2 equal parts and randomly allocated to 2 types of devices (TUP and MXL). A new device was used for each fragment. Each type of device was tested at 2 vacuum settings. When removing 1 polyp, the TIP (median time, 2:33 minutes [interquartile range (IQR), 1:32–3:27 minutes]), the MC (median time, 3:15 minutes [IQR, 2:42–3:42 minutes]), and the ML (median time, 3:00 minutes [IQR, 2:16–3:25 minutes]) performed significantly faster than the TI (median time, 14:09 minutes [IQR, 13:44–14:36 minutes]), by 84%, 78%, and 82% respectively (p < .001). The TIP performed 80% faster than the TI (median time, 2:27 minutes [IQR, 1:45–2:46 minutes] vs 10:37 minutes [IQR, 8:38–13:44 minutes]; p < .001) when removing a second polyp. For removal of a third polyp, the TIP performed significantly faster (median time, 2:22 minutes [IQR, 1:32–3:07 minutes]) than the TI (median time, 8:35 minutes [IQR, 7:37–9:03 minutes]) and the ML (median time, 10:02 minutes [IQR, 9:51–10:18 minutes]), by 74% and 78%, respectively (p < .001). The performance of the ML decreased (p < .001) during removal of 3 consecutive tissue samples. For myoma tissue, the estimated mean resection rate of the TUP (2.96 g/min [95% confidence interval (CI), 2.32–3.77 g/min]) was 24% (95% CI 0.2%–52.4%) higher than the mean resection rate of the MXL (2.39 g/min [95% CI 1.87–3.05 g/min]; p = .048). The resection rate of the MXL adjusted for vacuum setting declined by 3% per unit increase in myoma volume (95% CI, ?0.6% to ?5.7%; p = .02). For the TUP, no linear association was found (0.4%; 95% CI, ?2.1% to 3.0%; p = .72).Conclusion
In vitro comparison of the removal of surrogate polyps showed that although the larger TIP, MC, and ML devices were significantly faster than the TI for removal of 1 polyp, only the TIP was consistently faster than the TI for consecutive removal of polyps. The performance of the ML decreased significantly during removal of 3 consecutive tissue samples, making it slower than the TIP with a similar window size in the third run. For removal of myoma tissue, the resection rate of the TUP was significantly higher than that of the MXL, and the resection rate of the MXL decreased with increasing myoma volume. In vitro testing can provide useful information on the time and rate of hysteroscopic tissue removal. 相似文献13.
Clara Colomé Núria Parera Rebeca Fernández Ignacio Rodríguez Maite Cusidó 《Progresos de Obstetricia y Ginecología》2013
Introduction
The main objective of this study was to review the casuistics of adolescent women who consulted the Unidad de Ginecología de la Adolescencia del Institut Universitari Dexeus in Barcelona, Spain, for heavy uterine bleeding, as well as their treatments and outcomes.Material and methods
We performed a retrospective study of 178 adolescents treated between January 2005 and December 2009.Results
The severity of uterine bleeding was classified according to hemoglobin levels as mild (53.4%), moderate (11.2%) and severe (2.2%). Symptoms improved in 43% of the patients treated with iron therapy, 48% of those treated with non-steroidal anti-inflammatory drugs, 55% of patients who received antifibrinolytic agents, 59% of those treated with progestogens, 54% of patients who received estro-progestogens and 56% of those who received combined hormonal contraceptives.Conclusion
Heavy uterine bleeding is a common gynecological condition in adolescence, whose management and therapeutic measures are easy to apply. 相似文献14.
Gulden Menderes Belinda Nhundu Karen Levy Dan-Arin Silasi 《Journal of minimally invasive gynecology》2018,25(1):23
Study Objective
To demonstrate a technique for robotically resecting a parasitic leiomyoma from the obturator fossa.Design
Case report and a step-by-step video demonstration of resection of a symptomatic parasitic leiomyoma (Canadian Task Force classification III).Setting
Tertiary referral center in New Haven, Connecticut.Interventions
This 48-year-old Caucasian female had undergone a previous total abdominal hysterectomy for uterine leiomyomas. She presented to her primary care provider with lower back pain radiating to the right groin and with a burning sensation on the medial aspect of the inner thigh. She denied any decrease in leg muscle strength. Pelvic magnetic resonance imaging revealed a 3.3-cm mass in the obturator fossa compressing the obturator nerve. She was subsequently referred to gynecologic oncology for resection of the mass, and was brought to the operating room for robotic resection. Once retroperitoneum on the right pelvic sidewall was explored, ureterolysis was performed. The external iliac artery and vein were then mobilized medially to access the obturator fossa. The mass was visualized at the sidewall. Safe resection of the obturator fossa mass requires identification of the obturator nerve. The specimen was resected off the right pelvic sidewall with traction-countertraction, gentle wiping, and grasping-tenting techniques. It was then placed in a laparoscopic bag and removed from the peritoneal cavity in a contained manner. The procedure was performed without any complications. The patient had an uneventful postoperative course and was discharged to home on postoperative day 0. Pathology revealed a benign leiomyoma. The patient was symptom-free at her 4-week postoperative visit.Conclusion
Robotic resection of a symptomatic retroperitoneal mass in the obturator fossa was successfully performed, with resulting resolution of obturator neuropathy. Parasitic leiomyomas should be considered in the differential diagnosis for a patient presenting with an intraperitoneal or retroperitoneal mass with a history of previous surgery for leiomyomas. 相似文献15.
Christine M. Pennesi Brian Kenney Rajan Thakkar Christina Ching Geri Hewitt Katherine McCracken 《Journal of pediatric and adolescent gynecology》2018,31(6):640-643
Background
Heavy, prolonged menstrual bleeding is common in adolescents and results from a variety of etiologies.Case
A 13-year-old, virginal girl was referred for prolonged, heavy vaginal bleeding despite combined oral contraceptive use and elected management with a levonorgestrel intrauterine device. A preprocedure exam revealed a plastic foreign body embedded in the posterior vaginal fornix, however, attempted removal in the office was unsuccessful. Subsequent computed tomography imaging of the pelvis revealed a vaginal foreign body, complex adnexal mass, and hydroureter. The patient underwent exam under anesthesia and diagnostic laparoscopy, but required conversion to exploratory laparotomy for removal of a foreign body because of vaginal perforation abutting the rectum.Summary and Conclusion
Foreign bodies not easily removed in the outpatient setting should be considered for surgical removal with consideration of preoperative multidisciplinary coordination when imaging reveals intra-abdominal pathology, such as tubo-ovarian abscess and hydroureter. 相似文献16.
Nuri Peker Elif Ganime Aydeniz Savaş Gündoğan Fatih Şendağ 《Journal of minimally invasive gynecology》2017,24(1):8-9
Study Objective
To present a modified technique for laparoscopic cornual resection for the surgical treatment of heterotopic istmocornual pregnancy.Design
A step-by-step explanation of the surgery using video (Canadian Task Force Classification III-c).Setting
Heterotopic pregnancy is the coexistence of pregnancy in both the intrauterine and extrauterine sides. The incidence is 1 in 30 000 in spontaneous pregnancies; however, the incidence increased to 1 in 100 to 1 in 500 pregnancies with the increasing number of artificial reproductive technologies 1, 2. Although management is controversial, there are 2 main approaches classified as surgical and nonsurgical. The administration of potassium chloride, methotrexate, and/or hyperosmolar glucose is a nonsurgical intervention; however, there are some limitations such as systemic side effects and the possible adverse effect on a live fetus 1, 2, 3. For this reason, surgical intervention involving cornual resection is the main treatment option.Case Report
A 32-year-old patient was admitted to our clinic with sudden-onset pain at the left groin. She was at the 11th week of gestation. She had a diagnosis of infertility for 7 years, and she became pregnant after an in vitro fertilization cycle. At sonographic examination, 2 gestational sacs were detected, 1 with a live fetus settled into the uterus and the second (20-mm length) on the left cornual side without a yolk sac and embryo and the left adnexa accompanied with coagulated blood. Immediate laparoscopic surgery was planned. At the laparoscopic exploration, left istmocornual pregnancy that was ruptured and bleeding were observed. We performed a modified technique for laparoscopic cornual resection in which the uterine corn was tightened with the noose twice, and the corn was sutured circularly to avoid excessive bleeding. Initially, the mesosalpinx was coagulated and transected with bipolar energy. Afterward, the uterine corn was tightened with the noose twice, and the fallopian tube was removed. To reduce the bleeding during remnant cornual tissue extraction, a permanent 0 monofilament suture was passed deep into the myometrium and tightened to achieve better hemostasis. Then, the remnant cornual tissue was extracted with harmonic scissors, and the uterine wound was repaired with continuous suture to reduce the risk of uterine rupture during the ongoing pregnancy. Depot progesterone was administered just before the surgery and the day after. She was discharged on the first postoperative day. At the follow-up, she did not experience any problems during pregnancy, and she was delivered with cesarean section at 39 weeks’ gestation.Conclusion
In conclusion, laparoscopic surgery is a safe and feasible option for the treatment of heterotopic pregnancy, and control of bleeding can be achieved better with our modified technique. 相似文献17.
Wen-Liang Liao Tsung-Ho Ying Huang-Ping Shen Pei-Ju Wu 《Taiwanese journal of obstetrics & gynecology》2019,58(6):888-890
ObjectiveBig submucosal myoma often causes heavy menstrual bleeding and are complicated in hysterscopic surgery. High Intensity Focused Ultrasound (HIFU), is a method for myoma ablation therapy, which may benefit on size reduction, and assist following hysterscopic myomectomy.Case reportTwo cases, case one,. 44-year-old female with 3.8 cm submucosal myoma, STEPW (Size, Topography, Extension, Penetration and Wall) score 6 and case 2. 48-year-old female, with 6.0 cm submucosal myoma, STEPW score 8, both received HIFU treatment before hysterscopic myomectomy was done. The myomas reduced after 5 months with improvement of anemia. The following hysterscopic myomectomy shows less operative time and fewer blood loss.ConclusionHIFU reduce size of submucosal myoma and may improve anemia after months. Less operating time and blood loss were demonstrated in the following hysterscopic myomectomy. For well selected patients, combined treatment with HIFU and hysteroscopic resection may decrease complication rate. 相似文献
18.
Introduction
Radical resection of deep infiltrating endometriosis (DIE), including bladder and bowel resection, provides relief from pain in symptomatic patients. The laparoscopic approach to treatment is well established for bowel resection but normally requires additional abdominal incisions for specimen retrieval. Here we describe our technique of laparoscopically assisted rectal resection and transvaginal specimen retrieval (LARRT) and provide follow-up information on pain scores and complications.Materials and methods
Retrospective observational monocentric study on all DIE patients with rectal infiltration treated between 2008 and 2010 with LATRR at our department. Follow-up was obtained for at least 3 years, including baseline 1-year and 3-year pain scores.Results
We identified four patients undergoing LARRT available for follow-up. DIE was confirmed by histology in all cases. There were no intraoperative complications. Two patients had transient postoperative urinary retention, one patient developed recto-vaginal fistula and required transient colostomy. One patient suffered from persistent vaginal dryness. All patients, however, reported persistent pain relief, including at the end of follow-up period.Conclusion
LARRT is a feasible variation of laparoscopic bowel resection for DIE with rectal infiltration. In our study it has promising results with respect to pain control. Larger studies will, however, be required to determine the safety of this procedure.19.
Seckin B Ozdener T Tapisiz OL Batioğlu S 《Journal of pediatric and adolescent gynecology》2011,24(5):300-303
Study Objective
To investigate the laparoscopic management of ovarian cysts in adolescents and young adults.Design
A retrospective chart review study.Setting
Zekai Tahir Burak Women’s Health Research and Education Hospital.Participants
A total of 282 females aged 25 years or younger underwent laparoscopic surgery for a presumed benign ovarian cyst. Patients were grouped as adolescents (ages 12–19, n = 79) or young adults (ages 20–25, n = 203).Main Outcome Measures
Surgical approach, operative findings and the correlation of intraoperative diagnosis with the definitive pathological reports.Results
The mean age of the patients was 21.2 years. At laparoscopic surgery, 89 patients (31.6%) had endometriomas, 47 (16.7%) had dermoid cysts, and 37 (13.1%) had paraovarian cysts. Ninety-seven patients (34.4%) had simple ovarian cysts. Pathological reports revealed that young adults were more likely to have endometriomas (34.0% vs 7.6%, P < 0.01), but dermoid cysts and simple ovarian cysts were more frequent (20.3% vs 15.3%, P < 0.01 and 60.7% vs 40.9%, P < 0.01, respectively).in adolescents. Eleven of the cases (3.9%) were found to have mucinous cystadenomas and fourteen (5.0%) to have serous cystadenomas. Four cysts were malignant (1.4%). Cystectomy was performed in 205 cases (72.7%), fenestration of cyst wall was performed in 53 cases (18.8%), and aspiration was applied in 22 cases (7.8%). The types of operation were not significantly different among adolescents and young adults (P > 0.05). The operative diagnosis was highly correlated with the final pathological reports (kappa value= 0.901, P < 0.001). There were no operative and postoperative complications in our series.Conclusion
With a careful preoperative screening, the laparoscopic surgery of ovarian cyst is an efficient and safe treatment for adolescents and young adults. 相似文献20.
Emily Whelan B. Anthony Armson Jillian Ashley-Martin Kayla MacSween Christy Woolcott 《Journal of pediatric and adolescent gynecology》2017,30(3):356-361