硬膜外自控镇痛在子宫动脉栓塞术治疗子宫腺肌病中的应用

目的：探讨病人硬膜外自控镇痛（patient controlled epidural analgesia,PCEA)在子宫动脉栓塞术（uterine arterial embolization,UAE)治疗子宫腺肌病中的应用。方法：选择75例行UAE治疗子宫腺肌病的患者，随机分成3组，Ⅰ、Ⅱ组术前开始予自自控镇痛24小时，予相同的镇痛模型，两种不同的药物配伍：罗哌卡配伍吗啡为Ⅰ组（n＝30），罗哌卡因，吗啡配伍氟哌啶为Ⅱ组（n=30)，Ⅲ组术后自觉疼痛时予传统的肌注四氢巴马汀（颅痛定）或盐酸哌盐啶（n=15)，比较三组术中和术后24小时内的镇痛效果。不良反应安全性。结果：PCEAⅠ组、Ⅱ组的镇痛效果优于Ⅲ组，结合不良反应其临床疗效为：Ⅱ组＞Ⅰ组＞Ⅲ组。结论：UAE治疗子宫腺肌病术中应用PCEA镇痛效果好，不良反应小，舒适。安全。     

静脉和硬膜外自控镇痛法用于剖宫产术后镇痛的临床观察

目的观察患者静脉自控镇痛(PCIA)和硬膜外自控镇痛(PCEA)法用于剖宫产术后镇痛的效果.方法选取剖宫产术后患者240例,随机分成PCIA组、PCEA组和对照组,每组80例.PCIA组和PCEA组患者应用含吗啡20Mg、氟哌定醇5mg的自控镇痛(PCA)泵,根据术后疼痛程度患者自控给药.对照组患者则不用任何药物.采用视觉模拟评分法,分别观察3组患者术后的镇痛效果、肠蠕动恢复时间、拔尿管后排尿情况、产后出血、子宫复旧及泌乳情况和是否有恶心呕吐、皮肤搔痒及呼吸抑制情况.结果(1)PCIA组与PCEA组患者术后无明显疼痛感,镇痛效果良好,两组比较,差异均无显著性(P＞0.05);而对照组患者则有明显的术后疼痛感.(2)PCEA组患者的术后肠蠕动恢复时间为(17.51±10.33)h,明显快于PCIA组患者的(28.70±16.36)h,两组比较,差异有极显著性(P＜0.01).(3)PCIA组10例患者发生拔尿管后排尿困难,PCEA组为27例,两组比较,差异有显著性(P＜0.05);对照组仅有3例,明显少于PCIA组和PCEA组.(4)3组患者恶心呕吐、皮肤搔痒、呼吸抑制发生情况比较,差异均无显著性(P＞0.05).3组患者产后出血、子宫复旧及泌乳情况比较,差异均无显著性(P＞0.05).结论PCIA及PCEA均有良好的剖宫产术后镇痛效果.应用PCEA肠蠕动恢复快,但拔尿管后排尿困难发生率较PCIA为高,这类患者可采用延长拔尿管的时间来避免排尿困难的发生.     

剖宫产术后镇痛对泌乳素的影响

目的 :观察剖宫产术后产妇静脉自控镇痛 (PCIA)和硬膜外自控镇痛 (PCEA)对血浆泌乳素 (PRL)浓度的影响。方法 :选择足月妊娠拟行剖宫产孕妇 6 0 0例 ,随机分为PCIA组、PCEA组和对照组 ,各 2 0 0例。采用视觉模拟评分法(VAS)和Ramsay评分法测评产妇镇痛、镇静程度 ,用放射免疫分析法测定术前、术后 2 4小时及 48小时血浆PRL浓度。结果 :两镇痛组术后 2 4小时、48小时血浆PRL水平显著较对照组高。结论 :术后静脉和硬膜外镇痛能促进泌乳素的分泌。     

不同剂量罗哌卡因行双侧超声引导下腹横肌平面阻滞对子宫肌瘤腔镜剔除术患者术后镇痛效果的影响CSCD

目的 观察不同剂量罗哌卡因行双侧超声引导下腹横肌平面阻滞对子宫肌瘤腔镜剔除术患者术后镇痛效果的影响。方法 以中国人民解放军中部战区总医院2018年3月至2021年3月收治的90例子宫肌瘤腔镜剔除术患者为研究对象,依照区组随机化分组法将其分为治疗A、B、C三组各30例,术后均行双侧超声引导下腹横肌平面阻滞,镇痛用药分别为0.2%、0.15%和0.1%罗哌卡因30 ml,比较三组术后的镇痛效果,观察术后24、48 h三组患者的疼痛程度[视觉模拟评分(VAS)],统计三组术后的不良反应发生率。结果 治疗A组术后自主首次按压镇痛泵时间明显晚于治疗B组和治疗C组(P <0.05),治疗A组按压镇痛泵次数、48 h镇痛药物使用量明显低于治疗B组和治疗C组(P <0.05)。治疗A组术后24、48 h患者VAS评分明显低于治疗B组和治疗C组(P <0.05)。三组术后不良反应的总发生率差异均无统计学意义(P>0.05)。结论 30 ml 0.2%罗哌卡因行双侧超声引导下腹横肌平面阻滞对子宫肌瘤腔镜剔除术患者术后镇痛效果明确,能有效降低患者术后疼痛程度,且安全性良好,适宜于临床推广。     

妇科手术后罗哌卡因吗啡不同模式硬膜外病人自控镇痛对药效学的影响

目的　比较研究妇科手术后罗哌卡因 (Rop)、吗啡 (Mor)不同模式病人自控硬膜外镇痛 (PCEA)的效应。方法　选择经腹子宫全切术的病人 6 0例 (ASAⅠ～Ⅱ级 ) ,随机分成三组 ,均选双泵法。A泵镇痛液为0 2 %Rop ,B泵镇痛液为 0 0 1%Mor ;Ⅰ组 :A泵给药方法为每小时 2ml持续硬膜外输注 ,B泵以LP模式PCEA ;Ⅱ组 :A泵输注方法同Ⅰ组A泵 ,B泵以LCP模式PCEA ;Ⅲ组 :A泵输注为零 ,B泵给药方法同Ⅱ组B泵。结果　三组镇痛效果相似 ,而 2 4h硬膜外Rop药量Ⅱ组 >Ⅰ组 >Ⅲ组 ,PCEA所需的Mor剂量Ⅰ组最少。从 4h后PCA按压次数Ⅰ组 >Ⅱ组≈Ⅲ组 (P <0 0 5 ) ,术后 2h无运动阻滞的病人Ⅰ组为 40 % ,Ⅱ组为 45 % ,Ⅲ组为 76 % ,术后 4h三组病人均无运动阻滞。不良反应 :三组病人恶心呕吐发生率为 5 %～ 10 % ,无呼吸抑制。结论　Rop持续硬膜外输注时 ,吗啡PCEA以LP模式用药 ,在达到满意镇痛效应的情况下 ,能减少吗啡的消耗量 ,手术后 4h对病人无运动神经阻滞作用     

子宫切除术后硬膜外自控镇痛对机体免疫功能的影响

目的:探讨硬膜外自控镇痛(PCEA)对子宫切除术后机体免疫功能的影响。方法:选择择期施行腹式子宫切除术的患者6 0例,其中4 0例于手术结束后行PCEA(PCEA组) ,另2 0例于手术结束后肌内注射哌替啶止痛(对照组)。比较两组病例的镇痛效果,并分别测定术前2 4小时,术后2 4、72小时的血清免疫球蛋白IgG、IgA、IgM及补体C3、C4 含量。结果:①施行PCEA者术后伤口疼痛明显减轻;②术后2 4小时两组免疫球蛋白及补体含量均下降,但以对照组下降明显(P <0 .0 5 ) ,术后72小时PCEA组免疫球蛋白IgG、IgA与补体C3含量回升,IgM及补体C4 含量仍处于低水平,而对照组在术后72小时免疫球蛋白IgG、IgA、IgM及补体C3、C4 含量仍处于低水平。结论:子宫切除术后施行硬膜外自控镇痛能有效地减轻手术后伤口的疼痛,并能减轻应激反应所致的免疫抑制,从而保护机体的免疫功能,利于机体的康复。     

两种手术方法治疗子宫肌瘤围手术期护理比较构架

目的两种手术方法治疗子宫肌瘤围手术期护理比较构架。方法选取我院2017年3月~2019年3月收治的70例子宫肌瘤患者为研究对象,根据随机分组法将患者分为常规组(n=35)和研究组(n=35)。常规组采用传统开腹子宫肌瘤术治疗;研究组患者采用腹腔镜子宫肌瘤剔除术进行治疗。比较两组患者的术中出血量、手术时间、肛门排气时间和住院时间。结果研究组患者的术中出血量、手术时间、肛门排气时间和住院时间均优于常规组,差异具有统计学意义,P<0.05。结论腹腔镜子宫肌瘤剔除术治疗子宫肌瘤有着明显的疗效,临床效果更佳。     

子宫肌瘤子宫动脉栓塞术后疗效判定时间点研究

目的探讨子宫动脉栓塞术(UAE)治疗子宫肌瘤术后疗效合适的判定时间点。方法选取南方医科大学南方医院及广州市第一人民医院1999—2012年因子宫肌瘤行UAE治疗的具有相对完整随访资料的397例病例,术前及术后1、3、6、9个月、1年分别观察并记录子宫肌瘤体积变化及月经量改变情况。结果 UAE术后各时间点较术前相比,子宫肌瘤体积均显著缩小(P=0.000);UAE术后6个月较术后1个月及3个月时子宫肌瘤体积均显著缩小(P=0.000;P=0.002),而与术后9个月及1年相比,差异无统计学意义(P=0.673,P=0.104)。UAE术后6个月时月经量过多的患者月经量改善百分比与术后1个月、3个月差异均有统计学意义(P=0.026,P=0.044),但与术后9个月及术后1年相比,差异无统计学意义(P=0.495;P=0.099)。结论 UAE术后6个月是评价子宫肌瘤UAE术后疗效较为合适的时间。     

硬膜外注入罗哌卡因对全子宫切除术后镇痛效果及应激反应的影响

目的　研究硬膜外注入罗哌卡因的镇痛效果以及对应激反应的影响。方法　选 32例ASAⅠ -Ⅱ级子宫全切术患者 ,随机分为三组 ,生理盐水组 (Ⅰ组 ,n =10 ) ;罗哌卡因组 (Ⅱ组 ,n =11) ;吗啡组 (Ⅲ组 ,n =11)。术后分别经硬膜外分次推注生理盐水 ,0 2 %罗哌卡因和 0 0 2 %吗啡。注药后 2h、 6h时用线性视觉模拟法 (VAS)评定疼痛分数 ,同时测定血浆皮质醇 ,血糖以及胰岛素和血糖比值。结果　Ⅰ组术后VAS评分明显高于Ⅱ组和Ⅲ组 (P <0 0 1) ,而Ⅱ组和Ⅲ组VAS评分较低且恒定 ,且Ⅲ组副作用发生率明显高于Ⅰ组和Ⅱ组 (P <0 0 5 )。Ⅰ组术后血浆皮质醇 ,血糖浓度逐渐升高 ,并且在术后 6h明显高于Ⅱ组和Ⅲ组。Ⅰ组的胰岛素和血糖比值较Ⅱ组Ⅲ组低。Ⅱ组和Ⅲ组注药 6h后血浆皮质醇 ,血糖值均明显低于Ⅰ组 (P <0 0 5 )。结论　术后硬模外推注小剂量罗哌卡因镇痛效果可靠、副作用发生率低 ,可有效减轻下腹部术后应激反应 ,并优于硬膜外吗啡。     

子宫动脉栓塞术治疗粘膜下子宫肌瘤62例临床分析

目的:探讨子宫动脉栓塞术(UAE)治疗粘膜下子宫肌瘤的临床疗效。方法:回顾性分析UAE治疗粘膜下子宫肌瘤患者6 2例的疗效及临床转归。结果:6 2例患者随访1～6 3月,全部患者经量及经期恢复正常,粘膜下子宫肌瘤经阴道自然脱落排出4 0例,钳夹排出16例,进行性缩小消失4例,体积缩小>80 % 2例。术中、术后有不同程度的下腹痛(6 2例)、低热(12例)、阴道分泌物增多(6 2例,经对症处理后症状逐渐消失。结论:UAE可有效治疗粘膜下子宫肌瘤,并显著改善粘膜下子宫肌瘤的临床症状。     

Preemptive analgesia installation during gynecologic laparoscopy: a randomized trial

STUDY OBJECTIVE: To evaluate the efficacy of intraoperative infusion of bupivacaine solution for the relief of pain after operative gynecologic laparoscopy. DESIGN: Prospective, double-blind, randomized, controlled trial (Canadian Task Force classification I4). SETTING: Tertiary teaching hospital. PATIENTS: Ninety-one women aged 16 to 69 years who underwent gynecologic laparoscopic surgery from November 2002 through November 2003. INTERVENTIONS: Group A (n = 30): intraperitoneal infusion of a mixture of 10 mL of 0.5% bupivacaine (50 mg) with epinephrine (1:500) in 40 mL of Ringer's lactate solution postoperatively. Group B (n = 30): the same mixture solution infusion preoperatively and postoperatively (total 100 mg bupivacaine). Group C (n = 31): placebo. MEASUREMENTS AND MAIN RESULTS: Shoulder tip pain (STP), abdominal parietal pain (APP), and abdominal visceral pain (AVP) were recorded on a visual analog scale at 2, 4, 8, 16, and 24 hours postoperatively. A total of 79 patients fulfilled the study criteria. The overall incidence of STP was 60.8%. Abdominal visceral pain in group B was significantly less than in group C at 2 and 4 hours postoperatively (p = .011 and p = .010, respectively). No statistically significant difference was found in length of hospital stay, postoperative meperidine consumption, or side effects. CONCLUSION: Intraperitoneal bupivacaine administration both immediately after placement of trocars and at the end of surgery was found to be effective in reducing the intensity of AVP but not in reducing STP, APP, or postoperative analgesia consumption after nonadvanced gynecologic laparoscopic procedures. The duration of the analgesic effect of bupivacaine instilled into the peritoneal cavity did not exceed 8 hours and probably was not dose related.     

Comparison of oral naproxen and intrauterine lignocaine instillation for pain relief during hysterosalpingography.

Objectives: To compare the efficacy of oral naproxen with intrauterine instillation of 1% lignocaine for pain relief in women undergoing hysterosalpingography (HSG) as an infertility investigation. Methods: One hundred women undergoing HSG were randomly allocated into 2 groups. Group A (n = 50) underwent intrauterine instillation of 5 mL of 1% lignocaine 2 minutes prior to the procedure, while the women in group B (n = 50) were instructed to self-administer a single oral dose of 375 mg of naproxen 1 hour prior to HSG. Pain scores immediately after the procedure (0 minutes) and delayed pain scores (30 minutes) were recorded and compared. Results: Women in both groups were comparable in age and parity. The mean +/- SD pain scores in group A and group B at 0 minutes and 30 minutes were not significantly different (P = 0.12 and P = 0.07). Conclusion: Intrauterine lignocaine was no more effective than oral naproxen for pain relief during HSG.     

Patient-Controlled Epidural Analgesia After Caesarean Section Using a Disposable Deviee

Summary: We have evaluated the use of a disposable device, the Patient Controlled Epidural Infusor, for patient-controlled epidural analgesia (PCEA) using pethidine, for pain relief in the first 24 hours after elective Caesarean section. Patients using the Patient Controlled Epidural Infusor (n = 20) were compared with a control group (n = 20) who received PCEA using a standard electronic device. Efficacy, as assessed by visual analogue scores, was comparable to that achieved in the control group. Patient and nursing satisfaction was high and similar to that in die control group. There was a low incidence of side-effects with both devices. Patients using the disposable device used less pethidine than patients using the electronic device (median (interquartile range) 181 (100–275) mg versus 238 (213–375) mg; p = 0.035). Use of this disposable device is an acceptable alternative to more expensive and bulkier electronic devices for PCEA after Caesarean section.     

两种椎管内阻滞方法用于分娩镇痛的临床比较

目的探讨采用蛛网膜下腔与硬膜外腔分段阻滞联合用药及单纯硬膜外腔用药法的镇痛效果及其对母婴的影响。方法以蛛网膜下腔与硬膜外腔分段阻滞联合用药分娩镇痛者为研究组（１００例）,单纯硬膜外麻醉分娩镇痛者为对照组（４０例）,分别观察疼痛程度、副作用、产程时间、分娩方式、产后出血、胎儿窘迫及新生儿窒息情况。结果两组镇痛效果比较,差异有极显著性（Ｐ＜００１）,两组产程时间均值比较,差异无显著性（Ｐ＞００５）;两组产妇分娩方式、产后出血率、胎儿宫内窘迫及新生儿窒息发生率比较,差异无显著性（Ｐ＞００５）。结论蛛网膜下腔与硬膜外腔分段阻滞联合用药法,用于分娩镇痛安全有效。对产程及母婴均无影响,较单纯硬膜外麻醉镇痛效果更为肯定、满意,可在有一定条件的医疗单位应用。     

Differential analgesic effect of tenoxicam on post-cesarean uterine cramping pain between primiparous and multiparous women.

BACKGROUND AND PURPOSE: Uterine cramping pain is related to prostaglandins, which are mediated by cyclooxygenase. However, it is unknown whether the analgesic effects of the non-selective cyclooxygenase inhibitor tenoxicam are different between primiparous and multiparous women. This placebo-controlled, double-blind study compared the analgesic effect of tenoxicam on post-cesarean uterine cramping pain in primiparous and multiparous women. METHODS: Forty primiparous women and 40 multiparous women who were scheduled for elective cesarean delivery were allocated into the following 4 groups: saline-primipara (SP) group, tenoxicam-primipara (TP) group, saline-multipara (SM) group, and tenoxicam-multipara (TM) group. Saline or 20 mg tenoxicam was intravenously injected immediately after clamping of the umbilical cord. All patients received patient-controlled analgesia for postoperative pain control. Resting wound pain, uterine cramping pain, morphine consumption, and morphine-related side effects were evaluated at 4 and 24 hours after surgery. RESULTS: At 24 hours after surgery, tenoxicam-related relief of uterine cramping pain was 2.1 in primiparous women (visual analog scale: SP 5.6 (4.4-6.8) minus TP 3.5 (2.2-4.9); p < 0.01). The tenoxicam-related morphine-sparing effect was 14 mg (45%) in primiparous women (SP 31.4 mg (23.9-38.8) minus TP 17.4 mg (11.6-23.2); p < 0.01). The tenoxicam-related relief of uterine cramping pain and tenoxicam-related morphine-sparing effect were not significant in multiparous women. CONCLUSIONS: This study revealed that the analgesic effect of tenoxicam on post-cesarean uterine cramping pain is greater in primiparous women than in multiparous women. Further studies are required to determine whether a higher dosage of tenoxicam is beneficial to reduce uterine cramping pain in multiparous women.     

Cyproterone acetate versus a continuous monophasic oral contraceptive in the treatment of recurrent pelvic pain after conservative surgery for symptomatic endometriosis.

OBJECTIVE: To evaluate the efficacy and safety of cyproterone acetate versus an oral contraceptive in the treatment of endometriosis-associated recurrent pelvic pain. DESIGN: Randomized controlled trial. SETTING: Academic center. PATIENT(S): Ninety women with recurrent moderate or severe pelvic pain after conservative surgery for symptomatic endometriosis. INTERVENTION(S): Six months of continuous treatment with oral cyproterone acetate, 12.5 mg/d, or an oral contraceptive containing ethinyl estradiol, 0.02 mg, and desogestrel, 0.15 mg. MAIN OUTCOME MEASURE(S): Degree of satisfaction with therapy. RESULT(S): Six patients in the cyproterone acetate arm and nine in the oral contraceptive arm withdrew because of side effects (n = 9), treatment inefficacy (n = 4), or loss to follow-up (n = 2). At 6 months, dysmenorrhea, deep dyspareunia, and nonmenstrual pelvic pain scores were substantially reduced, and significant improvements were observed in health-related quality-of-life, psychiatric profile, and sexual satisfaction; no major between-group differences were seen. Subjective and metabolic side effects were limited. According to an intention-to-treat analysis, 33 of 45 (73%) of patients in the cyproterone acetate group and 30 of 45 (67%) in the oral contraceptive group were satisfied with the treatment received. CONCLUSIONS: Both cyproterone acetate and a continuous monophasic oral contraceptive were effective, safe, and inexpensive therapy for recurrent pain after conservative surgery for endometriosis.     

蛛网膜下腔阻滞加硬膜外阻滞与单纯硬膜外阻滞对产程进展影响的分析

目的探讨蛛网膜下腔阻滞(腰麻)加硬膜外阻滞与单纯硬膜外阻滞对产妇产程进展的影响。方法回顾性分析722例阴道分娩健康初产妇的临床资料,根据是否行分娩镇痛及分娩镇痛方法的不同分为3组:(1)腰麻加硬膜外阻滞(联合麻醉组),共259例;(2)单纯硬膜外阻滞(硬膜外组),共215例;(3)未采用任何镇痛方法的对照组,共248例。比较3组产妇产程时间及Friedman产程图进展变化特点。结果(1)第一产程活跃期、第二产程及第三产程时间比较:联合麻醉组分别为(272±127)min、(57±36)min及(9±6)min;硬膜外组分别为(305±133)min、(59±39)min及(8±6)min;对照组分别为(188±110)min、(45±32)min及(9±6)min。联合麻醉组及硬膜外组的第一产程活跃期及第二产程时间均长于对照组(P<0.01);3组间第三产程时间相互比较,差异均无统计学意义(P>0.05)。(2)产程图特点比较:联合麻醉组及硬膜外组产妇第一产程活跃期宫缩曲线位于产程图Friedman曲线右侧,对照组则位于其左侧;联合麻醉组和硬膜外组产程图宫口曲线较Friedman曲线倾斜角度小,即第一产程活跃期进展缓慢;对照组第一产程活跃期进展较快。联合麻醉组产妇平均每小时宫口开大1.5cm,硬膜外组产妇为1.4cm,对照组产妇为1.8cm。联合麻醉组及硬膜外组产妇平均每小时宫口开大程度较对照组缩小,两者比较,差异有统计学意义(P<0.01)。结论腰麻加硬膜外阻滞联合麻醉及单纯硬膜外阻滞镇痛后,产妇第一产程活跃期进展减慢,总产程时间延长;镇痛后的产程处理不应单纯按照Friedman产程图进行。     

Patient -controlled epidural ropivacaine as a post-Cesarean analgesia: a comparison with epidural morphine

ObjectiveConventional, intermittent, epidural morphine is widely applied as a post-Cesarean delivery analgesia. We compared the analgesic efficacy, motor weakness, and side effects of administering a patient-controlled epidural analgesia (PCEA) of pure ropivacaine versus the intermittent administration of epidural morphine after Cesarean delivery.Materials and MethodsThis randomized, double-blind study included 120 full-term parturients who underwent elective Cesarean delivery and received either PCEA with pure ropivacaine or an intermittent bolus epidural of 2 mg/10 mL morphine in normal saline twice per day. The efficacy of pain relief, post-Cesarean side effects, motor blockades, time to first ambulation, and global satisfaction scores were evaluated.ResultsPain scores were recorded at the four evaluation times (2, 12, 24, and 48 hours post-Cesarean delivery), and the time to first ambulation did not statistically differ between the two groups. Patients in the ropivacaine group experienced more motor weakness at 2 and 12 hours, fewer side effects, and higher global satisfaction scores than those in the morphine group (p < 0.05).ConclusionThe analgesic efficacy after cesarean delivery was almost equivalent between two groups. PCEA with pure ropivacaine induced significant motor blockade during the first 12 hours, but without delaying the time to first ambulation. Patients in the ropivacaine group reported higher patient satisfaction scores due to the significant reduction of annoying side effects, such as pruritus, nausea, vomiting, and urinary retention.     

Laparoscopic occlusion of uterine vessels for the treatment of symptomatic fibroids: Initial experience and comparison to uterine artery embolization

OBJECTIVE: Our purpose was to evaluate the effects of laparoscopic occlusion of uterine vessels in treating symptomatic fibroids and compare with embolization of the uterine arteries. STUDY DESIGN: We studied 46 premenopausal women, aged 43 (34-51) years with symptomatic uterine fibroids, undergoing radiologic embolization (n=24) and laparoscopy closure of the uterine arteries (n=22). RESULTS: The laparoscopic technique reduced picture blood assessment score after 6 months by 50% from an initial value of 345 (+/-288). Uterus volume was reduced by 37% (+/-18%), and the dominant fibroid was reduced by 36% (+/-31%). Postoperative pain and use of pain relief differed significantly, requiring more pain medication after embolization: ketobemidon 38 mg compared with 16 mg in the laparoscopic group (P=.008). Specific complications to the laparoscopic technique were temporary damage to the obturator nerve in three patients. CONCLUSION: Laparoscopic occlusion of uterine vessels is a promising new method for treating fibroid-related symptoms, with less postoperative pain than embolization and comparable effects on symptoms.