Glasser Mark H
Department of Obstetrics and Gynecology, Kaiser Permanente Medical Center, San Rafael, California 94903, USA.
J Minim Invasive Gynecol. 2005 May-Jun;12(3):275-83. doi: 10.1016/j.jmig.2005.03.009.
To assess the efficacy of performing myomectomies through 3- to 6-cm incisions for the removal of myomas up to 14 cm in diameter.
A retrospective analysis of 139 myomectomies performed at our center from January 1995 through December 2003 (Canadian Task Force classification II-3).
A suburban medical center, part of a large prepaid health maintenance organization.
One hundred thirty-nine women.
Myomectomies were performed through 3- to 6-cm suprapubic cruciate incisions using atraumatic elastic retractors with or without laparoscopic assist. Myomas were morcellated with a scalpel before being enucleated. The uterus was repaired in a classic three-layered closure in all cases. All procedures were performed in the ambulatory surgery unit of our hospital, which is part of the main operating room.
The median age of the patients in this series was 30.0 years (range 23-56 years). The median weight of the myomas removed was 275.0 g (range of 30-975 g). One hundred thirty-seven (98.5%) of 139 patients were discharged in 23 hours or less, with 24 patients leaving within 4 hours and 61 within 8 hours. The median length of stay was 6.0 hours, with two patients remaining hospitalized for 48 hours. The median operating time was 110 minutes (range 44-260 min). Estimated blood loss ranged from 50 to 2000 mL, with a median of 300 mL. Three hysterectomies were performed: one as an emergency for hemorrhage and two for recurrent myomas. Three patients developed wound seromas, and one developed a wound infection.
Minilaparotomy myomectomy is a safe, effective minimally invasive alternative to laparoscopic myomectomy. Early discharge and return to normal activities is comparable to laparoscopy and is far more cost effective. It affords the ability to palpate the uterus and close the myometrial defect easily with a standard three-layered closure making it particularly suitable for gynecologists with limited laparoscopic suturing skills.
评估通过3至6厘米切口进行子宫肌瘤切除术以切除直径达14厘米肌瘤的疗效。
对1995年1月至2003年12月在我们中心进行的139例子宫肌瘤切除术进行回顾性分析（加拿大工作组分类II - 3）。
一个郊区医疗中心，是大型预付费健康维护组织的一部分。
139名女性。
使用无创伤弹性牵开器，通过3至6厘米耻骨上十字形切口进行子宫肌瘤切除术，有或无腹腔镜辅助。在摘除肌瘤前用手术刀将其切碎。所有病例均采用经典的三层缝合修复子宫。所有手术均在我院门诊手术单元进行，该单元是主手术室的一部分。
本系列患者的中位年龄为30.0岁（范围23 - 56岁）。切除肌瘤的中位重量为275.0克（范围30 - 975克）。139例患者中有137例（98.5%）在23小时或更短时间内出院，其中24例在4小时内出院，61例在8小时内出院。中位住院时间为6.0小时，2例患者住院48小时。中位手术时间为110分钟（范围44 - 260分钟）。估计失血量为50至2000毫升，中位失血量为300毫升。进行了3例子宫切除术：1例因出血紧急进行，2例因肌瘤复发进行。3例患者出现伤口血清肿，1例出现伤口感染。
小切口开腹子宫肌瘤切除术是一种安全、有效的微创替代腹腔镜子宫肌瘤切除术的方法。早期出院和恢复正常活动与腹腔镜手术相当，且成本效益更高。它能够触诊子宫，并通过标准的三层缝合轻松关闭子宫肌层缺损，特别适合腹腔镜缝合技术有限的妇科医生。
