腹腔镜下子宫肌瘤剥除术中先行子宫动脉阻断可行性研究

目的:探讨腹腔镜下子宫动脉阻断后行肌瘤剥除治疗子宫肌瘤的临床效果及可行性.方法:根据不同方法对120例要求保留子宫的子宫肌瘤患者随机分为两组.研究组60例,采用腹腔镜下双侧子宫动脉阻断后行肌瘤剥除术;对照组60例,采用腹腔镜下常规子宫肌瘤剥除术.肌瘤数目、大小、发病年龄两组间差异无统计学意义.统计手术时间、术中出血量,术后定期随访观察月经症状的改变,B超检查监测子宫大小及肌瘤复发情况,并将两组进行对照比较.结果:研究组平均手术时间(92.5±31.2)分钟,与对照组(103.8±48.6)分钟相近(P＞0.05);研究组术中出血量(87.5±48.4)ml,明显少于对照组(233.0±86.0)ml(P＜0.05);两组随访均在2年以上,平均随访26个月,研究组失访9例,对照组失访8例;研究组术后2年所有患者E2值均在正常范围;术后2年,研究组和对照组94.1%和78.8%的患者子宫恢复到正常大小,两组比较差异有统计学意义;研究组月经症状缓解率93.6%,明显高于对照组79.1%(P＜0.05);肌瘤复发率3.9%,明显低于对照组23.1%(P＜0.05).结论:腹腔镜下子宫动脉阻断后行肌瘤剥除治疗子宫肌瘤与常规腹腔镜下肌瘤剥除术相比,能明显减少术中出血,更好地缓解月经过多等症状,延缓了肌瘤的复发,具有更好的临床应用价值.     

腹腔镜与开腹手术施行子宫肌瘤切除术的临床对照分析

目的　探讨腹腔镜下子宫肌瘤切除术的手术方法、适应证、术后疗效及临床应用价值。方法　回顾性分析比较腹腔镜子宫肌瘤切除术 86例 (观察组 )和开腹子宫肌瘤切除术 72例 (对照组 )患者的手术情况和术后情况。结果　观察组中单发肌瘤 72例 ,多发肌瘤 14例 ,剔出肌瘤 10 2个 ,肌瘤直径 1～ 11cm ,平均 (5 16± 1 88)cm。对照组中单发肌瘤 5 6例 ,多发肌瘤 16例 ,剔出肌瘤 94个 ,肌瘤直径 2～ 18cm ,平均 (6 13± 2 92 )cm。观察组手术时间 (82 0 9± 2 3 5 1)min ,对照组手术时间 (84 6 5± 30 4 8)min(P >0 0 5 )。观察组术中出血 (33 14±2 4 0 2 )mL ,对照组术中出血 (85 5 6± 6 5 13)mL(P <0 0 1)。观察组术后平均 (1 2 8± 0 90 )d体温恢复正常 ,对照组术后平均 (2 82± 1 2 5 )d体温恢复正常 (P <0 0 1)。观察组术后住院 (4 2 2± 1 0 0 )d ,对照组术后住院(6 74± 1 6 7)d(P <0 0 1)。结论　腹腔镜子宫切除术具有创伤小、术中出血少、术后恢复快及住院时间短等优点 ,是目前较为理想的微创手术治疗子宫肌瘤的方法之一。     

腹腔镜下改良子宫肌瘤切除术218例临床分析

目的探讨腹腔镜下改良子宫肌瘤切除术的可行性。方法将218例改良腹腔镜下子宫肌瘤切除手术患者作为研究组,传统腹腔镜下子宫肌瘤切除术214例作为对照组,比较两组患者的手术及并发症情况。结果研究组的手术时间为（86．5±32．2）min,术中出血量为（127．8±32．8）m1,术后排气时间为（21．2±2．6）h;对照组的手术时间为（100．6±29．9）mIn,术中出血量为（168．7±22．5）rnl,术后排气时间为（38．2±1．O）h,两组患者的手术时间、术中出血量和术后排气时间比较,差异均有统计学意义（P〈O．05）。研究组术后镇痛率为27．5％（60／218）、术后病率为2．3％（5／218）,对照组术后镇痛率为63．1％（135／214）,术后病率4．2％（9／214）,两组比较,差异均有统计学意义（P〈O．05）。结论腹腔镜下改良子宫肌瘤切除术手术时间短,术中失血少,术后肛门排气早,住院时间短,是安全可行的手术方式。     

腹腔镜下子宫血管阻断治疗子宫肌瘤的最初经验及与子宫动脉栓塞治疗的比较

为了解腹腔镜下子宫血管阻断治疗有症状子宫肌瘤的价值．选择46例绝经期前，平均年龄43（34～51）岁，有临床症状的子宫肌瘤患者纳入研究。组其中（24例）采用放射介导子宫动脉栓塞治疗．组2（22例）采用腹腔镜下子宫血管阻断治疗．组2操作要点为近髂内动脉水平以腹腔镜内铗阻断子宫动脉．同时双极电凝处理卵巢固有韧带以阻断卵巢与子宫的交通血供。对两组术后子宫出血的改变情况．子宫及子宫肌瘤的体积变化情况及术后疼痛及镇痛药的使用情况进行评估分析。     

子宫黏膜下和肌壁间肌瘤合并不育患者子宫肌瘤切除术后妊娠结局

目的了解子宫黏膜下和肌壁间肌瘤合并不育患者行子宫肌瘤切除术后的妊娠情况及影响妊娠的相关因素。方法对2000年1月至2012年12月河北医科大学第二医院妇产科113例子宫肌瘤合并不孕或流产患者的临床资料进行回顾性分析,其中黏膜下肌瘤53例,肌壁间肌瘤60例,行宫腔镜下子宫肌瘤电切术（TCRM）或经腹／腹腔镜／阴道子宫肌瘤切除术,观察术后妊娠及相关因素情况。结果113例患者术后妊娠81例（71．7％）,其中黏膜下肌瘤患者妊娠率为81_1％（43／53）,肌壁间肌瘤患者妊娠率为63．3％（38／60）。81例妊娠患者中,71例足月分娩,6例早产,新生儿均存活。无子宫破裂发生。患者年龄〉35岁、不孕年限〉2年、肌壁间肌瘤最大直径≥6cm和数目≥4个者术后妊娠率明显降低（P均〈0．05）,而黏膜下和肌壁间子宫肌瘤位置、缝合层数、手术时间、术中出血量等与术后妊娠率无明显关系（P〉0．05）。结论对黏膜下和肌壁间子宫肌瘤合并不育的患者行子宫肌瘤切除术可明显改善妊娠结局,患者年龄、不孕年限、肌壁间肌瘤大小和数目是术后妊娠率的影响因素。     

悬吊式无气腹腹腔镜与气腹腹腔镜在子宫肌瘤切除术中的多中心、随机对照研究

目的：比较悬吊式无气腹腹腔镜与气腹腹腔镜在子宫肌瘤切除术中的可行性、安全性及手术效果。方法：将3家医院收治的474例子宫肌瘤患者随机分为2组,分别采用悬吊式无气腹腹腔镜（239例）和传统气腹腹腔镜（235例）行子宫肌瘤切除术。比较2组患者的手术时间、术中出血量、术中切除肌瘤数、术后腹腔引流量、术后体温持续时间、肛门排气时间等情况。结果：两种手术方式均能完成子宫肌瘤的切除。悬吊式腹腔镜组和气腹腹腔镜组的平均手术时间分别为（65．5±12．5）min和（100．O±10．5）rain,剥除肌瘤数目分别为（6．0±1．4）个和（2．2±1．3）个,术中失血量分别为（110．5±30．5）ml和（250．4±35．3）ml,术后腹腔引流量分别为（120．5±23．0）ml和（260．2±31．5）ml,均差异显著（P〈O．01）;而术后体温持续时间、肛门排气时间和平均住院时间均无显著差异（P〉0．05）。结论：悬吊式无气腹腹腔镜与气腹腹腔镜均能成功地进行子宫肌瘤的切除,但悬吊式无气腹腹腔镜显示出更多的优势。     

经阴道多普勒血流超声检查对子宫肌瘤血流动力学特点的研究

目的：研究子宫肌瘤患者的肌瘤血流及子宫动脉血流动力学特点。方法：对50例绝经前与10例绝经后子宫肌瘤患者（研究组）及21例绝经前与10例绝经后无子宫肌瘤者（对照组）进行经阴道多普勒血流超声检查。结果：研究组子宫动脉（UA）的搏动指数（PI）与阻力指数（RI）明显低于对照组（绝经前P＜0．01、P＜0．05；绝经后P＜0．05、P＜0．02）；收缩末期最大速度（A）和舒张末期速度（B）均高于各自的对照组，P＜0．001）；血流量（BFV）明显高于对照组（绝经前产＜0．002；绝经后P＜0．001）。绝经前有月经改变和无月经改变者的所有多普勒参数之间差异无显著性（P＞0．05），表明子宫体积、肌瘤体积与子宫动脉RI、BFV之间有高度相关性。此外，发现20％（10／50）绝经前肌瘤患者和60％（6／10）绝经后肌瘤患者的肌瘤假膜处血流RI＜0．40，术后病理学检查均证明为良性子宫平滑肌瘤。结论：本研究结果表明，绝经前、后子宫肌瘤患者UA及宫壁血管血流动力学均发生改变，BFV明显增加，RI值降低。     

腹腔镜子宫动脉阻断并子宫肌瘤剔除术28例临床观察

1995年，Ravina等报道子宫动脉栓塞术（UAE）治疗子宫肌瘤取得成功，引起广大学者的关注，目前已有大量的临床报道。但UAE术后7—20天内，因肌瘤栓塞后局部缺血，缺血性盆腔痛高达90％以上，发热率26％，下肢酸胀无力60％等，给患者造成很大的痛苦。1999年中国台湾省刘伟民首创腹腔镜子宫动脉阻断术治疗子宫肌瘤，疗效与UAE相似，但并发症减少。     

腹腔镜下子宫肌瘤切除术58例分析

目的:探讨腹腔镜子宫肌瘤切除术的安全性和效果。方法:腹腔镜下对58例子宫肌瘤患者行肌瘤切除术,其中肌壁间和无蒂浆膜下肌瘤52例,有蒂浆膜下肌瘤2例,阔韧带肌瘤4例,切开肌瘤前子宫肌层内注入垂体后叶素6u。结果:58例手术均一次成功,术中出血量10～600ml(平均110.1±65.5ml),手术时间25～195min(平均105.2±26.5min),术后病率0,术后住院时间3～5d。结论:腹腔镜下子宫肌瘤切除术具有微创手术的一切优点,如能严格掌握适应症,这是一种安全有效的手术方法。     

用腹腔镜行子宫肌瘤切除术的分析

目的：分析腹腔镜子宫肌瘤切除术的手术效果,研讨该手术的适应证、手术技巧及并发症。方法：行腹腔镜子宫肌瘤切除术 ７４例,肌瘤直径≥ ３ｃｍ。手术指征包括肌瘤引起疼痛或尿频等症状２０例,肌瘤生长快１７例,合并附件病变２６例以及不育２１例。结果：每例患者肌瘤１－４个,其中单发肌瘤６２例（８２．４％）,前壁肌瘤３０例（４０．５％）,后壁肌瘤２３例（３１．１％）,宫底肌瘤２１例（２８．４％）,共切除肌瘤 ９３个,包括 １６个壁间肌瘤及对个浆膜下肌瘤,肌瘤直径 ３－ ８ｃｍ,平均 ４．８ｃｍ。１９例（２５．５％）子宫切口进行了缝合。平均手术时间及术中出血量为７３ｍｉｎ及 ８２ｍｌ,肌瘤≥４ｃｍ比肌瘤＜ ４ｃｍ者手术时间及术中出血量明显增加（ Ｐ＜ ０．０１,Ｐ＜０．０５）,术后住院时间平均为３．２ｄ,并发症率为１．４％。术后随诊平均２２月（１～６２月）。术后２月随诊时,术前有症状者术后均改善。１例复发再次行腹腔镜子宫肌瘤剔除术。２１例不育者５例妊娠,４例足月行选择性剖宫产术,术中未发现肌瘤切除部位明显粘连,１例自然流产。结论：中等大的浆膜下肌瘤或单发肌壁间肌瘤行腹腔镜子宫肌瘤切除术效果好,并发症率低,但术后妊娠率及复发率尚需进一步     

腹腔镜与开腹子宫肌瘤剔除术后肌瘤残留、复发及妊娠结局的比较

目的：比较子宫肌瘤患者腹腔镜与开腹子宫肌瘤剔除术的手术学特点、术后肌瘤残留、复发情况及妊娠结局。方法 回顾性分析2008年1月至12月在北京协和医院同期行腹腔镜或开腹子宫肌瘤剔除术461例患者的临床资料,腹腔镜313例、开腹148例,比较其一般情况、围手术期特点、术后残留、复发及妊娠结局。结果开腹患者剔除最大肌瘤直径(7.6±3.0) cm、剔除肌瘤数目(5.6±5.5)个、剔除肌瘤重量(308 ±364)g均高于腹腔镜患者[分别为(6.8±2.0) cm、(2.4±2.1)个、(140±109)g],分别比较,差异均有统计学意义(P＜0.01)。与腹腔镜患者相比,开腹患者的手术时间长[分别为(74 ±35)、(89±32) min]、术中失血量增多[分别为(149±252)、(239±251)ml]、围手术期血红蛋白含量降低程度增大[分别为(15±12)、(22±14) g/L]、术后住院时间增加[分别为(4.4±1.3)、(6.4±1.6)d],分别比较,差异均有统计学意义(P＜0.01)。然而,腹腔镜与开腹患者术后残留率（分别为2.6％、1.4％）、复发率（分别为11.1％、12.3％）、术后妊娠率(分别为49.2％、9/13)比较,差异均无统计学意义（P＞0.05）。肌瘤数目是影响复发的主要因素（OR=2.805,95％CI为1.192 ～6.601,P=0.0180）。所有术后妊娠患者均未发生妊娠中子宫破裂。结论腹腔镜与开腹子宫肌瘤剔除术是有生育要求或要求保留子宫患者的有效、安全的治疗方式。大部分的子宫肌瘤手术可以通过腹腔镜完成。腹腔镜子宫肌瘤剔除术的术后残留率高于开腹术式,但术后短期复发率相近。多发肌瘤是复发的主要危险因素;肌瘤数目≥4个者腹腔镜子宫肌瘤剔除术后复发率增加。腹腔镜与开腹子宫肌瘤剔除术后妊娠率相当。     

Treatment of uterine fibroids for abnormal uterine bleeding: myomectomy and uterine artery embolization

Uterine myoma is a common benign tumour in women and most cases do not require treatment. Excessive uterine bleeding is usually due to a submucous myoma or an intramural myoma that is encroaching into the uterine cavity. After eliminating endometrial malignancy, perimenopausal women could be managed expectantly or with gonadotrophin-releasing hormone agonist until menopause. Hysteroscopic myomectomy is highly effective in controlling menorrhagia that is related to submucous myoma. Concomitant endometrial ablation improves menorrhagia; however, the subsequent hysterectomy rate remains the same. For those with an intramural myoma, abdominal myomectomy results in good bleeding control. It could also be done by laparoscopic approach; however, the surgeon should have expertise in laparoscopic suturing and the uterine incision should be properly sutured. In women who have completed their family, hysterectomy remains the most effective treatment for excessive uterine bleeding. Compared with uterine artery embolization (UAE), it is associated with better improvement in pelvic pain. Nevertheless, UAE is a good alternative to hysterectomy.     

难治性产科出血时子宫切除术和子宫动脉栓塞术的临床分析

目的探讨产科急性出血性疾病治疗过程中进行子宫切除术和动脉栓塞术的临床特点以及选择时机。方法回顾性分析35例产科出血因素行子宫切除或者动脉栓塞病例的临床资料。结果16例子宫切除的患者中,胎盘因素10例,占62.5%（前置胎盘/胎盘植入7例,胎盘早剥伴有凝血功能障碍3例）,子宫异常4例（子宫收缩乏力2例、子宫切口延裂致阔韧带血肿和子宫破裂各1例）占25%;羊水栓塞致DIC后切除子宫2例占12.5%。19例行子宫动脉栓塞术中,前置胎盘3例,占15.8%,子宫收缩异常13例（原发性宫缩乏力产程中剖宫产4例、双胎4例,急产产后出血2例,巨大儿1例,巨大子宫肌瘤2例）占68.4%,剖宫产并发症3例（子宫切口延裂致阔韧带血肿和子宫动脉瘤各1例,剖宫产术后晚期产后出血1例）占15.8%,其中2例栓塞失败,分别行子宫切除术和开腹探查血肿清除术。子宫切除术平均出血量（4 593±2 727）ml,子宫动脉栓塞术时平均出血量（2 601±904）ml,两组比较差异有统计学意义（P〈0.05）。子宫切除组有11例出现了DIC表现占68.7%。行子宫动脉栓塞术时发生DIC1例,占10.5%,差异有统计学意义（P〈0.05）。结论二者均为治疗产后出血的有效手段,但是栓塞术作为保守治疗可以保留生育功能,对于改善患者的预后具有重要的意义,要求尽早采用,一旦发生了严重的DIC和休克,则失去了机会。而保守治疗不能短时间见效,应果断行子宫切除术。     

环氧合酶-2在子宫肌瘤组织中的表达及其意义

目的观察环氧合酶-2（cyclooxygenase,COX-2）在子宫肌瘤与子宫平滑肌组织中的表达,探讨COX-2与子宫肌瘤发病机制的相关性。方法选择2010年1月至2010年8月在上海市杨浦区中心医院行腹腔镜下子宫肌瘤切除术的30例患者的子宫肌瘤组织为实验组,并取其邻近的正常平滑肌组织为对照组,采用免疫组化方法检测COX-2的表达;并采用蛋白印迹法及实时荧光定量逆转录聚合酶链反应分别在蛋白水平和基因转录水平检测标本中COX-2的表达。结果免疫组化检测实验组和对照组均有COX-2蛋白表达,平滑肌细胞阳性指数（MPI）为11．90,子宫肌瘤细胞阳性指数（FPI）为46．50,两者比较,差异有统计学意义（P〈O．05）。蛋白印迹法结果显示,COX-2在实验组（O．872±0．035）中的表达明显高于对照组（O．202土0．056）,两者比较,差异有统计学意义（P〈0．05）。COX-2mRNA在实验组（0．122±0．062）中的表达也高于对照组（0．025±0．009）,两者比较,差异有统计学意义（P〈0．05）。结论COX-2在子宫肌瘤的表达明显高于子宫平滑肌,COX-2可能在子宫肌瘤的发病机制中起重要作用。     

子宫肌瘤、卵巢囊肿病理组织中PAEs含量的测定与分析

目的:测定子宫肌瘤、卵巢囊肿患者血清及病理组织中酞酸酯类化学物(PAEs)水平并分析其相关性。方法:收集80例子宫肌瘤和67例卵巢囊肿患者的手术病理组织和血液样本,采用气相色谱法(GC)测定PAEs含量。并对病理组织与血清中邻苯二甲酸二丁酯(DBP)和邻苯二甲酸二(2-乙基-己基)酯(DEHP)水平进行相关性分析。结果:患者病理组织中DEP、DBP和DEHP的检出率分别为0、74.8%和99.3%。卵巢囊肿病理组织中DBP和DEHP水平分别为0.457μg/g和4.123μg/g,均显著高于子宫肌瘤组织(0.202μg/g、2.317μg/g,P<0.001)。子宫肌瘤患者血清中DEHP与病理组织中DBP和DEHP的水平均呈负相关(r=-0.241,P<0.05;r=-0.309,P<0.01);卵巢囊肿患者血清中DBP与病理组织中DBP含量呈负相关(r=-0.255,P<0.05);卵巢囊肿患者的黄体生成素水平显著低于子宫肌瘤患者(3.80IU/L vs 8.72IU/L,P<0.05)。结论:PAEs对女性人群暴露与子宫肌瘤、卵巢囊肿发病的相关性研究有一定的参考意义。     

Successful pregnancy in a woman with symptomatic fibroids who underwent laparoscopic bipolar coagulation of uterine vessels

OBJECTIVE: To report a case of successful pregnancy after laparoscopic bipolar coagulation of uterine vessels (LBCUV). DESIGN: Case report. SETTING: University-affiliated tertiary referral center. PATIENT(S): One woman, treated with LBCUV for symptomatic fibroids, who subsequently had a successful pregnancy. INTERVENTION(S): Laparoscopic bipolar coagulation of uterine arteries and anastomotic sites of uterine arteries with ovarian arteries. MAIN OUTCOME MEASURE(S): Patient evaluation by physical and ultrasound examinations. RESULT(S): Complete resolution of menorrhagia and dysmenorrhea was found after LBCUV. Reduction in fibroid size was seen by ultrasound. Two months later, the patient conceived a singleton pregnancy without the use of assisted reproductive technologies. The woman delivered by cesarean section. Neither myoma recurrence nor abnormality in uterine function was observed. CONCLUSION(S): Although fecundity- and pregnancy-related complications after LBCUV for managing uterine fibroids are still unclear, this first case report of successful pregnancy after LBCUV is promising. LBCUV might be a safe and effective alternative to myomectomy and hysterectomy.     

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.     

Transvaginal radiofrequency thermal ablation: a day-care approach to symptomatic uterine myomas

Background: In patients with myoma, the traditional surgical treatment of choice is myomectomy for women who wish to retain their uterus. However, myomectomy must be performed under general anaesthesia, and the patient requires a long time to recover.
Aims:  In the present study, we report our experience with a group of patients who underwent transvaginal radiofrequency (RF) thermal ablation of uterine myomas, with emphasis on the safety and efficacy of this procedure.
Methods:  Premenopausal women with symptomatic uterine myoma or recently growing myoma were included in this study. The pre- and postoperative myoma volumes were measured by 3D ultrasonography. The impact of the symptoms on health-related quality of life (HRQL) was assessed using the Uterine Fibroids Symptom and Quality of Life questionnaire.
Results:  The mean initial size of the dominant myoma was 5.3 cm (standard deviation ± 1.58). The reoperation rate was 4.3%. The final reduction rate of the volume of the dominant fibroid was 73%. The symptom scores and HRQL scores showed great improvement after 18 months of myolysis.
Conclusions:  The results of this study suggest that RF ablation may represent a safe, well-tolerated, and effective day-care alternative to conventional surgery for the treatment of uterine myomas.     

Laparoscopic uterine artery occlusion combined with myomectomy for uterine myomas

We sought to evaluate the clinical feasibility and mid- to long-term effects of laparoscopic uterine artery occlusion before myomectomy in the treatment of uterine myomas. A total of 566 patients with uterine myoma were treated by laparoscopic uterine artery occlusion before myomectomy from October 2001 through July 2007. Mean blood loss was 88.2 +/- 52.7 mL (95% CI 82.7-93.8). The highest postoperative temperature was 37.8 +/- 0.3 degrees C, and the postoperative morbidity was 5.7% (32/566). Number of days to the return of bowel movement was 1.9 +/- 0.5d and in hospital stay after surgery was 7.7 +/- 2.5d. Complications included 2 instances of subcutaneous emphysema, 1 of vaginal bleeding, and 3 of mild intestinal obstruction. At a median of 26.3 months (range 6-69 months) of follow-up, the rate of myoma recurrence was 3.0% (15/517), uterus volume reduction was 48.9%, and correction of menstruation abnormality was 97.1% (502/517). Laparoscopic uterine artery occlusion before myomectomy can expand myomectomy indications with better results.     

Combining the uterine depletion procedure and myomectomy may be useful for treating symptomatic fibroids

OBJECTIVE: To evaluate the therapeutic results of premyomectomy uterine depletion for the treatment of symptomatic fibroids, compared with myomectomy only. DESIGN: Controlled, clinical study without randomization. SETTING: University-affiliated tertiary referral center. PATIENT(S): Four hundred eighty-six women with symptomatic fibroids warranting surgical treatment and who wished to retain their uteri. INTERVENTION(S): Ligation of the uterine arteries was performed by either an abdominal or a laparoscopic approach before myomectomy. MAIN OUTCOME MEASURE(S): Operation time, intraoperative blood loss, postoperative improvement of symptoms, and recurrence rates of fibroids. RESULT(S): Of 342 women with pathology-confirmed fibroids who were included in the study, 108 received myomectomy only (group I), and 234 underwent the uterine depletion procedure followed by myomectomy (group II). Average blood loss was 250 +/- 132.5 mL for group I and 50 +/- 26.9 mL for group II. For patients with menorrhagia, 79 (84%) of 94 women in group I experienced complete resolution; all of the 194 women (100%) in group II had resolution within 2 months of surgery. The recurrence rate of ultrasound-confirmed fibroids was 19.4% (21 of 108) in group I and 0% in group II. Of the sexually active patients who were not using contraception, 50% (49 of 98) in group I and 37.5% (15 of 40) in group II had a live birth. CONCLUSION(S): This study demonstrates the value of uterine depletion before myomectomy for the management of patients with symptomatic fibroids. The procedure reduced blood loss during the operation, resulted in complete resolution of fibroid-related menorrhagia, and has the potential to prevent fibroid recurrence. Fertility capacity was apparently not compromised by this new treatment approach.