腹腔镜子宫肌瘤剔除术治疗子宫肌瘤的效果研究

目的探究子宫肌瘤患者治疗中腹腔镜子宫肌瘤剔除术的应用效果。方法共计有48例子宫肌瘤患者参与本次研究,所有患者均于我院2018年3月~2019年3月进行手术治疗,对照组实施经腹子宫肌瘤剔除术治疗,研究组实施腹腔镜子宫肌瘤剔除术治疗,分组对比手术中出血量、手术后住院时间以及并发症发生情况。结果手术中出血量、手术后住院时间以及并发症对比研究组低于对照组,差异有统计学意义(P<0.05)。结论子宫肌瘤患者治疗中腹腔镜子宫肌瘤剔除术的操作效果显著,能够有效提升治疗效果,降低手术后各类并发症的发生,提升治疗安全性,具有较高的临床推广及应用价值。     

腹腔镜子宫肌瘤剔除术与开腹子宫肌瘤剔除术的治疗效果比较

目的 分析子宫肌瘤患者采取不同手术治疗方案对其预后的影响。方法 选取30例子宫肌瘤患者,采取随机数字表法分为对照组（15例,采用开腹子宫肌瘤剔除术治疗）与研究组（15例,采用腹腔镜子宫肌瘤剔除术治疗）。比较两组患者的手术指标、预后恢复情况、并发症发生情况、手术前后卵巢功能指标及炎性因子水平。结果 研究组的手术时间短于对照组,术中出血量少于对照组（P<0.05）。研究组的胃肠功能恢复时间、术后下床时间及住院时间均较对照组短（P<0.05）。研究组并发症发生率6.67%明显低于对照组的40.00%(P<0.05)。研究组术后的卵巢功能指标、炎性因子水平均显著优于对照组（P<0.05）。结论 腹腔镜子宫肌瘤剔除术治疗子宫肌瘤患者,有助于加快患者的预后恢复,提高临床疗效,同时也提升安全性,具有临床应用价值。     

腹腔镜下子宫肌瘤剔除术治疗子宫肌瘤的临床效果

目的 探讨腹腔镜下子宫肌瘤剔除术治疗子宫肌瘤的临床效果.方法 选取99例子宫肌瘤患者,根据手术方法不同分为研究组(56例)与对照组(43例).研究组采用腹腔镜下子宫肌瘤剔除术治疗,对照组采用常规开腹手术治疗.对比两组手术相关指标、术后并发症发生情况及复发率.结果 研究组术中出血量(57.63±3.40)ml明显少于对照...     

DDI评分系统预测腹腔镜子宫肌瘤剔除术的结局

生育年龄妇女子宫肌瘤临床发病率为20％-40％^[1]，在手术病理标本中的检出则高达77％^[2]。腹腔镜子宫肌瘤剔除术（Iaproscopic myomectomy，LM）患者创伤小、康复快、腹部无明显疤痕，但腹腔镜下剔除肌瘤缝合瘤腔、止血等技术操作难度较大，若辅以下腹部4-6cm长的小切口，可使手术难度明显下降，     

妇产科子宫肌瘤腹腔镜剔除术效果探讨

目的：探讨对患有子宫肌瘤的妇女使用腹腔镜子宫肌瘤剔除术的效果。方法：选取患有子宫肌瘤的妇女64例,平均分为两组,分别为实验组和对照组各32例。其中实验组使用腹腔镜子宫肌瘤剔除术进行治疗。对照组则应用传统的开腹手术进行治疗。对两组患者的术前、术中和术后的各项指标进行定量及定性的比较分析。结果：经观察对比发现,实验组在术中出血量（61．36±10．39）ml,住院时间（5．39±1．27）d等各项指标均优于对照组（87．36±15．59）ml。（9．17±2．09）d,其差异在统计学允许范围内。结论：相对于传统手术,对于患子宫肌瘤的患者采用腹腔镜子宫肌瘤剔除术效果更佳,建议该微创手术临床使用推广。     

腹腔镜下子宫肌瘤剔除术与经腹子宫肌瘤剔除术治疗的预后分析

目的对比分析子宫肌瘤患者采用腹腔镜下子宫肌瘤剔除术与经腹子宫肌瘤剔除术治疗的预后。方法选取本院2016年6月~2019年1月期间收治的预行手术治疗的子宫肌瘤患者20例作为研究对象,将其随机分为两组,各10例。实验组行腹腔镜下子宫肌瘤剔除术;对照组行经腹子宫肌瘤剔除术。对比两组患者术后切口恢复时间、月经恢复时间、平均住院时间。结果实验组患者术后伤口恢复时间、月经恢复时间、平均住院时间明显短于对照组,差异具有统计学意义,P<0.05。结论子宫肌瘤患者采用腹腔镜下子宫肌瘤剔除术治疗患者的预后更佳,值得推广。     

腹腔镜超声在腹腔镜子宫肌瘤剔除术中的应用价值

目的:探讨腹腔镜超声(LUS)在腹腔镜子宫肌瘤剔除术中的应用价值。方法:收集48例子宫肌瘤患者,常规腹腔镜子宫肌瘤剔出术后,采用LUS行残存病灶扫查定位,引导术者切除病灶,并与术前超声及术后病理结果比较。术后3、6、9、12个月超声复查。结果:腹腔镜手术切除病灶后,由LUS探查发现残余病灶23例,均定位成功剥除。48例中5例经LUS结合腹腔镜手术探查后更正了术前诊断。术后随访1年,发现新增肌瘤患者4例,子宫肌瘤复发率为8.33%。结论:LUS可指导妇科医师在腹腔镜下有效清除病变,减少残余病灶及术后复发;LUS在腹腔镜子宫肌瘤术剔除术中具有良好的应用前景。     

腹腔镜子宫肌瘤剔除术40例临床分析

目的:探讨腹腔镜子宫肌瘤剔除术的临床应用价值。方法:对40例子宫肌瘤患者行腹腔镜下子宫肌瘤剔除术。结果:40例手术全部成功,其中浆膜下肌瘤22例、壁间肌瘤18例,肌瘤直径4~8cm。手术平均时间88.13±30.44分钟。术中出血91.27±83.41ml。术后体温最高37.8℃,2天后恢复正常,术后住院4.87±1.20天。结论:腹腔镜子宫肌瘤剔除术是一种安全有效的手术方法,其优点是损伤小、出血少、恢复快,是目前较为理想的微创手术治疗子宫肌瘤的方法之一。     

腹腔镜下子宫肌瘤剔除术的临床进展

子宫肌瘤是女性生殖器官最常见的良性肿瘤，发生率为20％-30％。治疗症状性子宫肌瘤最常采用的治疗方法是子宫切除术。近年来，随着越来越多的妇女选择晚生育，并且更加重视子宫的生理功能以及身体的完整性，子宫肌瘤剔除术正在日益增加。自1990年，腹腔镜下子宫肌瘤剔除术(laparoscopic myomectomy，LM)取代开腹手术治疗肌壁间     

腹腔镜子宫肌瘤剔除术相关临床问题

腹腔镜子宫肌瘤剔除术已经成为治疗子宫肌瘤的重要术式,具有微创手术的优点。但由于腹腔镜手术本身的特点和技术局限,正确选择手术适应证和掌握良好的手术技巧,对保证手术效果,减少近期和远期的手术并发症尤其重要。     

The effect of lateral uterine artery dissection on clinical outcomes in laparoscopic myomectomy: a prospective randomized study

This study assessed the effect of lateral uterine artery dissection (LUAD) on clinical outcomes in laparoscopic myomectomy (LM). Fifteen women with symptomatic fibroids (dominant fibroid size: 3–6 cm) were randomly allocated to laparoscopic myomectomy (group 1) and 16 women to the combined operative procedures LM and LAUD (group 2). We assessed the clinical outcomes: intra-operative and postoperative blood loss, operating time, hospital stay, hemoglobin fall, inflammatory response and tissue markers [C-reactive protein (CRP), creatinin kinase and white blood cells (WBC)]. The mean operating time was 69.5 min in group 1 and 76.5 min in the group 2, and the mean length of hospital stay was 2.6 days versus 2.1 days, respectively (P>0.05). For the laparoscopic myomectomy and combined operative procedure, respectively, the intra-operative blood loss was 134 ml (10–400 ml) and 93.7 ml (10–200 ml) (P>0.05); the difference (92.4 ml vs. 46 ml ) in estimated postoperative blood loss was statistically significant (P<0.05), and the decline in the hemoglobin level was 1.2 g/dl^-1 (group 1) versus 0.6 g/dl^-1 (group 2) on the 3rd postoperative day (P<0.05). Group 2 demonstrated a less intense stress response in terms of CRP (P<0.001) and WBC (P<0.01). The LUAD had little impact on intraoperative blood loss. This may be due to the smaller fibroid size, but the statistical difference in hemoglobin fall on the 3rd postoperative day was significant. The dissection of the uterine artery in laparoscopic myomectomy is a feasibile surgical procedure with a low rate of complication.     

Comparison of cesarean delivery outcome after robotic and laparoscopic myomectomy

ObjectiveThe aim of this study was to determine whether robotic myomectomy (RM) resulted in any measurable clinical improvement over laparoscopic myomectomy (LM) in subsequent cesarean delivery.Materials and methodsThe medical records of 273 patients who had undergone LM or RM followed by subsequent cesarean delivery for the period of September 2015 to December 2020 were retrospectively reviewed. The patients were divided into LM (n = 222) and RM (n = 51) groups. The cesarean delivery outcomes between the two groups were compared.ResultsRM had significantly more myomas removed (6.0 ± 4.8 vs. 3.6 ± 3.5, p < 0.001) and a larger size of largest myoma (7.7 ± 2.4 vs. 6.1 ± 2.4, p = 0.002) at myomectomy compared with LM. However, there were no significant differences in the groups’ surgical characteristics at cesarean section, in their pregnancy complications, or in adhesion formation.ConclusionsAlthough more and larger myomas were removed in the RM group, RM showed similar cesarean delivery outcomes and adhesion formation to LM.     

Pregnancy outcomes after treatment for fibromyomata: uterine artery embolization versus laparoscopic myomectomy

OBJECTIVE: The objective of this study was to compare pregnancy outcomes in women with fibromyomata who were treated with uterine artery embolization to the outcomes in women who were treated with laparoscopic myomectomy. STUDY DESIGN: We compiled data from 53 pregnancies after uterine artery embolization and 139 pregnancies after laparoscopic myomectomy. We calculated and compared rates for spontaneous abortion, postpartum hemorrhage, preterm delivery, cesarean delivery, small for gestational age, and malpresentation. RESULTS: Pregnancies after uterine artery embolization had higher rates of preterm delivery (odds ratio, 6.2; 95% CI, 1.4, 27.7) and malpresentation (odds ratio, 4.3; 95% CI, 1.0, 20.5) than did pregnancies after laparoscopic myomectomy. The risks of postpartum hemorrhage (odds ratio, 6.3; 95% CI, 0.6, 71.8) and spontaneous abortion (odds ratio, 1.7; 95% CI, 0.8, 3.9) after uterine artery embolization were similarly higher than the risks after laparoscopic myomectomy; however, these differences were not statistically significant. CONCLUSION: Pregnancies in women with fibromyomata who were treated by uterine artery embolization, compared with pregnancies after laparoscopic myomectomy, were at increased risk for preterm delivery and malpresentation.     

The role of laparoscopic dissection of the uterine artery in the surgical treatment of fibroid-related menorrhagia: a pilot study

This pilot study assessed the outcome, tissue trauma, clinical improvement and reduction in size of fibroids following laparoscopic dissection of the uterine artery (LDUA) in fibroid-related menorrhagia. Fifty-three patients with complete records were included in the prospective clinical study. Before LDUA, and 3 and 6 months following the procedure, ultrasonography or MRI was done to measure the size of the uterus and dominant fibroid. Blood samples for hemoglobin and assay of marker inflammatory response and tissue trauma were taken preoperatively on the 1st and 3rd postoperative days. All patients underwent successful LDUA using ultrasonically activated shears without intra-operative complications. Fifty (96.2%) laparoscopically treated patients with fibroids who subsequently experienced improvement in menorrhagia and anemia are described. The LDUA procedure can be completed within 30–40 min with only minimal blood loss and a short hospital stay if performed by experienced surgeons. Our study results show that single laparoscopic dissection of the uterine artery performed with ultrasonic technique is associated with an insignificant stress response. The average reductions in the uterine volume and dominant fibroid volume were 36.6 and 57.9% at 6 months after surgery, respectively. Four women conceived within 1 year, and their pregnancies were without complications during gestation.     

Surgical management of uterine fibroids in Hesse, Germany, between 1998 and 2004

OBJECTIVE: To identify and evaluate surgical management of women with uterine fibroids. DESIGN: Retrospective analysis of mandatory surgical data sent to the Institute for Quality Assurance. SETTING: Data collection from 1998 to 2004 in Hesse, Germany. PATIENT(S): 34,814 women who underwent surgery for uterine fibroids. INTERVENTION(S): Patients were treated with either myomectomy or hysterectomy. MAIN OUTCOME MEASURE(S): Statistical analysis of mandatory surgical parameters. RESULT(S): Altogether, 4975 (14.3%) women had myomectomies, and 29,839 (85.7%) had hysterectomies. Age was an important determinant of surgical procedure; hysterectomy was preferred for patients over 40 (odds ratio 4.3; 95% confidence interval: 4.1-4.5). Laparoscopic myomectomy rates increased from 25.9% in 1998 to 41.9% in 2004; during the same period, the proportion of conversion procedures and abdominal approaches fell from 15.6% to 2.9% and 38.9% to 30.9%, respectively. Intraoperative complication rates were similar for myomectomy (1.1%) and hysterectomy (1.0%), but postoperative complication rates were higher for hysterectomy (5.8%) than myomectomy (3.2%). CONCLUSION(S): The increasing use of endoscopic procedures was an important feature in this series and appeared to be safe. The reduction of conversion rates and intraoperative complications might be related to improvements in surgical skill. Acceptance of the benefits of endoscopic approaches seems to have promoted its steady growth as a primary surgical approach.     

Uterine rupture at 33rd week of gestation after laparoscopic myomectomy with signs of fetal distress. A case report and review of literature

Objective

We describe a case of uterine rupture (UR) during pregnancy after laparoscopic myomectomy (LM) and discuss the risk factors of UR.

Patients' satisfaction with laparoscopic myomectomy

Background. Laparoscopic myomectomy offers a uterus-conserving alternative to hysterectomy for patients suffering from symptomatic myomas. The following study aimed to examine clinically relevant aspects of perceived satisfaction following laparoscopic myomectomy.

Method. 191 women completed a 17-item questionnaire on retrospective satisfaction with their choice for the operation and with the surgical outcome (e.g., “all myomas were removed”, “termination of discomfort”). A comparison was performed using questionnaire data, patients' demographical data and surgical records (e.g., duration of surgery).

Results. Women who trusted in their decision for the surgical procedure revealed better surgical outcome and greater satisfaction with the treatment process than those who were insecure with their choice. Age did not influence the patients' perceived satisfaction. In anticipation of the surgical outcome, patients placed stronger emphasis on tissue preservation than on their wish for a child or on the termination of discomfort.

Conclusions. The high overall level of satisfaction and positive outcome in various age groups contradicts current recommendations against laparoscopic myomectomy for women over 40 years of age.