Gávai Márta, Hupuczi Petronella, Papp Zoltán
Semmelweis Egyetem, Altalános OrvostudományiKar, I. Szülészeti es Nogyógyászati Klinika, Budapest.
Orv Hetil. 2006 May 28;147(21):971-8.
Surgical management of symptomatic uterine fibroids by abdominal myomectomy.
Authors review their experiences and surgical methods for 504 abdominal myomectomies performed over the last 15 years. They retrospectively analyze the annual number of myomectomies, the age distribution, the most frequent indications, the location, size, and number of leiomyomas, the number of cases in which the uterine cavity was opened, the frequency of post-operative complications, and the number and outcome of post-myomectomy pregnancies.
The annual number of myomectomies increased 26 times over the 15 year period, the average age at myomectomy was 33 years, 1.8% of post-fertile patients desired surgery which allowed for conservation of the uterus. The three most frequent indications for myomectomy were abdominal pain, infertility and menorrhagia. Regarding location, size and number; 82.7% of fibroids were submucosal/intramural and/or larger than 7 cm and/or greater than three in number. The uterine cavity was opened in 112 cases (22.2%). Post-operative complications occurred in 67 cases (13.3%): 7.7% required transfusions, 2.2% needed repeat laparotomy, two of which resulted in hysterectomy, and fever occurred in 13 cases (3.0%). There were 122 (24.2%) pregnancies in 105 patients following myomectomy. Eighty-nine patients conceived once, 15 patients conceived twice and 1 patient conceived three times post-myomectomy. There were 26 spontaneous abortions representing 5.2% of the post-myomectomy patients and 21.3% of the conceived pregnancies. There were 96 deliveries in 19.0% of the patients who had myomectomy and 78.7% of the total conceived pregnancies.
Authors suggest that abdominal myomectomy for the therapy of symptomatic uterine fibroids is an effective surgical alternative to hysterectomy one, which preserves fertility and femininity. In cases where the fibroids have well-defined borders, the success of surgery does not depend on the location, size or number of fibroids. In cases with adenomyosis, myomectomy alone is not sufficient to alleviate the symptoms. When the uterine cavity is opened during surgery, post-operative transcervical drainage is suggested to prevent hematometra, post-operative adhesions inside the uterus, infection, fever and wound dehiscence.
经腹子宫肌瘤切除术治疗有症状的子宫肌瘤。
作者回顾了过去15年中504例经腹子宫肌瘤切除术的经验和手术方法。他们回顾性分析了每年的子宫肌瘤切除例数、年龄分布、最常见的适应证、平滑肌瘤的位置、大小和数量、打开子宫腔的病例数、术后并发症的发生率以及子宫肌瘤切除术后妊娠的数量和结局。
在15年期间，每年的子宫肌瘤切除例数增加了26倍，子宫肌瘤切除的平均年龄为33岁，1.8%的绝经后患者希望通过手术保留子宫。子宫肌瘤切除术最常见的三个适应证是腹痛、不孕和月经过多。关于位置、大小和数量；82.7%的肌瘤为黏膜下/肌壁间和/或大于7厘米和/或数量超过三个。112例（22.2%）打开了子宫腔。67例（13.3%）发生术后并发症：7.7%需要输血，2.2%需要再次剖腹手术，其中两例导致子宫切除术，13例（3.0%）出现发热。子宫肌瘤切除术后，105例患者中有122例（24.2%）妊娠。89例患者子宫肌瘤切除术后受孕一次，15例患者受孕两次，1例患者受孕三次。有26例自然流产，占子宫肌瘤切除术后患者的5.2%，占受孕妊娠的21.3%。19.0%接受子宫肌瘤切除术的患者分娩96次，占总受孕妊娠的78.7%。
作者认为，经腹子宫肌瘤切除术治疗有症状的子宫肌瘤是子宫切除术的一种有效的手术替代方法，可保留生育能力和女性特征。在肌瘤边界清晰的情况下，手术的成功不取决于肌瘤的位置、大小或数量。在合并子宫腺肌病的情况下，单纯子宫肌瘤切除术不足以缓解症状。手术中打开子宫腔时，建议术后经宫颈引流以预防积血、子宫内术后粘连、感染、发热和伤口裂开。
