Dubuisso J B, Fauconnier A, Babaki-Fard K, Chapron C
Service de chirurgie gynécologique, Clinique universitaire Baudelocque, CHU Cochin--Saint Vincent de Paul, Paris, France.
Hum Reprod Update. 2000 Nov-Dec;6(6):588-94. doi: 10.1093/humupd/6.6.588.
Since 1990 laparoscopic myomectomy (LM) has provided an alternative to laparotomy when intramural and subserous myomata are to be managed surgically. However, this technique is still the subject of debate. Based on their own experience together with data from the literature, the authors report on the situation today regarding the operative technique for LM and the risks and benefits of the technique as compared with myomectomy by laparotomy. The operative technique comprises four main phases: hysterotomy; enucleation; suture of the myomectomy site and extraction of the myoma. LM offers the possibility of a minimally invasive approach to treat medium-sized (<9 cm) subserous and intramural myomata by surgery when there are only two or three of them. When conducted by experienced surgeons, the risk of peri-operative complications is no higher using this technique. Use of the laparoscopic route could reduce the haemorrhagic risk associated with myomectomy. LM could reduce also the risk of post-operative adhesions as compared with laparotomy. Spontaneous uterine rupture seems to be rare after LM but further studies are needed before it can be said whether the strength of the hysterotomy scars after LM is equivalent to that obtained after laparotomy. The risk of recurrence seems to be higher after LM than after myomectomy performed by laparotomy.
自1990年以来，当需要手术治疗壁间肌瘤和浆膜下肌瘤时，腹腔镜子宫肌瘤切除术（LM）为剖腹手术提供了一种替代方法。然而，这项技术仍存在争议。基于作者自身的经验以及文献数据，他们报告了目前LM手术技术的情况，以及与剖腹子宫肌瘤切除术相比该技术的风险和益处。手术技术包括四个主要阶段：子宫切开术；肌瘤剜除术；子宫肌瘤切除部位的缝合以及肌瘤取出。当只有两三个中等大小（<9 cm）的浆膜下和壁间肌瘤时，LM提供了一种通过手术进行微创治疗的可能性。由经验丰富的外科医生进行时，使用该技术围手术期并发症的风险并不更高。采用腹腔镜途径可降低与子宫肌瘤切除术相关的出血风险。与剖腹手术相比，LM还可降低术后粘连的风险。LM术后自发性子宫破裂似乎很少见，但在能够确定LM术后子宫切开术瘢痕的强度是否与剖腹手术后相当之前，还需要进一步研究。LM术后复发的风险似乎高于剖腹子宫肌瘤切除术。
