经阴道与经腹子宫肌瘤剔除术的比较

目的探讨经阴道子宫肌瘤剔除术的可行性、安全性及临床疗效.方法对92例子宫肌瘤分别施行经阴道肌瘤剔除术(研究组,n=46)及开腹肌瘤剔除术(对照组,n=46),并对两种术式的临床疗效进行比较.结果经阴道与经腹肌瘤剔除术均获成功.手术时间研究组与对照组比较差异无显著性(t=-0.734, P=0.465);平均术中出血量、术后肛门排气时间、术后疼痛、术后病率、住院日期研究组与对照组比较差异均有显著性.结论经阴道子宫肌瘤剔除术具有创伤小、术中出血少、术后肛门排气早、疼痛轻、术后病率低及住院时间短的优点,是一种安全可行的微创手术方式.但须正确掌握适应证.     

Operative morbidity and reproductive outcome in secondary myomectomy: a prospective cohort study

BACKGROUND: This prospective study was designed to evaluate the operative morbidity and reproductive outcome in patients who had secondary myomectomy for recurrent symptomatic uterine fibroids. METHODS: A total of 58 women were subjected to a secondary myomectomy via the abdominal route. The operative morbidity such as blood loss, presence of adhesions and febrile index were estimated and the pregnancy outcome over a 2-4 year period of follow-up. RESULTS: The mean age and standard deviation (+/- SD) of the women was 35 (+/- 2.4) years. Nineteen patients (33%) had a postoperative temperature vertical line 100 degrees F and the estimated blood loss ranged from 159-2500 ml (median 700 ml). Seven patients (12%) required blood transfusion and one had a hysterectomy due to haemorrhage. Nine women (15.5%) became pregnant but only five (56%) had live births. Those with successful pregnancies tended to be younger with a mean age of 31.8 (+/- 2.6) years versus 35 (+/- 1.8) years, (P = 0.08, non-significant) and had fewer uterine leiomyomata; median with range values, 2 (1-6) versus 7 (6-15). The variables which best predicted the postoperative likelihood of pregnancy were; age, presence of tubal adhesions and the number of uterine fibroids. CONCLUSION: This prospective study showed a high operative morbidity and a poor fertility outcome after a repeat myomectomy. The factors affecting successful outcome in a logistic regression model were age, tubal adhesions and number of uterine fibroids.     

Fibroids, infertility and pregnancy wastage

Uterine fibroids are often found in women of reproductive age. Different types of fibroids may affect reproductive outcome to a different extent, with submucous, intramural and subserosal fibroids being (in decreasing order of importance) a cause of infertility and pregnancy wastage. Fibroids may also produce a number of complications during pregnancy. Women who are scheduled for assisted conception should be advised to have submucous and possibly intramural fibroids removed prior to IVF. Large fibroids (>5 cm), wherever their location, should be considered individually, with the reproductive history being an important consideration. Miscarriage rates are significantly reduced following myomectomy. Open myomectomy should be the route of choice when there are large subserosal or intramural fibroids, multiple fibroids or entry into the uterine cavity is to be expected. Proper assessment of the benefits and risks of surgery for individual patients should be carefully considered before offering a procedure.     

晚期妊娠合并子宫肌瘤治疗的探讨

目的　探讨晚期妊娠合并子宫肌瘤的最佳临床处理方法。方法　对 6 7例晚期妊娠合并子宫肌瘤病例的治疗进行回顾性分析。结果　 6 7例妊娠合并子宫肌瘤患者中 ,单发肌瘤4 2例 ,多发肌瘤 2 5例 ;其中经阴道分娩 12例 ;剖宫产 5 5例 ;剖宫产加肌瘤剔除术 4 0例 ,剖宫产加子宫次全切除术 3例。结论　妊娠合并子宫肌瘤患者剖宫产率高 ,大部分病例可在剖宫产同时行肌瘤剔除术。     

Reproductive outcome after laparoscopic myomectomy for intramural myomas in infertile women with or without associated infertility factors

Aims:   To evaluate reproductive outcome after laparoscopic myomectomy for intramural myomas in infertile women with or without associated infertility factors.
Methods:   A retrospective study was carried out in 30 infertile women with intramural myomas measuring ≥50 mm in diameter and treated using laparoscopy.
Results:   The overall rate of spontaneous intrauterine pregnancy was 50.0% (15 patients). Of 13 patients with infertility factors associated with the uterine myomas, three (23.1%) became pregnant, whereas 12 of 17 patients (70.6%) with no other associated infertility factor became pregnant. No uterine ruptures were observed. All pregnancies were spontaneous and 13 occurred within 1 year of the operation. In the 10 patients who gave birth by Cesarean section, no adhesions were found on the myomectomy scar.
Conclusions:   On the basis of these results, laparoscopic surgery for myomas appears to offer comparable results to laparotomy. In infertile patients with intramural myoma, pregnancy rates are affected by the presence of other infertility factors associated with the uterine myomas. (Reprod Med Biol 2006; 5 : 31–35)     

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.     

子宫肌瘤的复发及其处理

肌瘤大、多发、肌壁间肌瘤是3个与生长方式相关的子宫肌瘤复发的危险因素;年轻、发病早、孕产次少、体重指数大等是与患者自身情况相关的危险因素。子宫肌瘤复发治疗原则与原发肌瘤相似,再次手术的术式选择应该关注前次手术后粘连等问题,个体化选择治疗方案。　     

情绪释放疗法对腹腔镜子宫肌瘤剔除术病人疼痛程度、不良情绪、术后恢复及满意度的影响

目的:探讨情绪释放疗法对腹腔镜子宫肌瘤剔除术病人疼痛程度、不良情绪及术后恢复的影响。方法:选择2019年11月—2021年6月医院c4病区收治的腹腔镜子宫肌瘤剔除术病人80例,随机分为对照组与观察组,各40例。对照组行常规干预,观察组行情绪释放疗法干预。比较两组病人手术后疼痛程度、不良情绪、术后恢复效果及满意度。结果:干预后观察组病人术后6 h、24 h的视觉模拟评分法(VAS)评分明显低于对照组(P<0.05);观察组病人术后2 d的汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评分明显低于对照组(P<0.05);观察组病人术后肛门首次排气时间、腹胀消失时间、术后首次排便时间、肠鸣音恢复时间、首次下床时间、术后住院时间均明显短于对照组(P<0.05);观察组病人术后满意度明显高于对照组(P<0.05)。结论:情绪释放疗法能明显缓解腹腔镜子宫肌瘤剔除术病人疼痛程度,减轻其不良情绪,提升满意度,促进术后早日康复。