Di Spiezio Sardo Attilio, Mazzon Ivan, Bramante Silvia, Bettocchi Stefano, Bifulco Giuseppe, Guida Maurizio, Nappi Carmine
Department of Gynaecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples Federico II, Italy.
Hum Reprod Update. 2008 Mar-Apr;14(2):101-19. doi: 10.1093/humupd/dmm041. Epub 2007 Dec 6.
Hysteroscopic myomectomy currently represents the standard minimally invasive surgical procedure for treating submucous fibroids, with abnormal uterine bleeding and reproductive issues being the most common indications. While hysteroscopic myomectomy has been shown to be safe and effective in the control of menstrual disorders, its effects on infertility remain unclear. The review provides a comprehensive survey of all hysteroscopic techniques used to treat fibroids found completely within the uterine cavity (G0) and those with intramural development (G1 and G2). MEDLINE and EMBASE searches identified published papers from 1970. The choice of the technique mostly depends on the intramural extension of the fibroid, as well as on personal experience and available equipment. 'Resectoscopic slicing' still represents the 'gold standard' technique for treating fibroids G0, even if several other effective techniques including ablation by neodymium-yttrium-aluminum-garnet laser, morcellation and office myomectomy have been proposed. On the other hand, the present review clearly indicates that there is still no single technique proven to be unequivocally superior for treating fibroids G1 and G2. Most techniques aim at the transformation of an intramural fibroid into a totally intracavitary lesion, thus avoiding a deep cut into the myometrium. At present, the 'cold loop' technique seems to represent the best option as it allows a safe and complete removal of such fibroids in just one surgical procedure, while respecting the surrounding healthy myometrium.
宫腔镜子宫肌瘤切除术目前是治疗黏膜下肌瘤的标准微创手术，异常子宫出血和生殖问题是最常见的适应证。虽然宫腔镜子宫肌瘤切除术已被证明在控制月经紊乱方面安全有效，但其对不孕症的影响仍不明确。本综述全面调查了用于治疗完全位于子宫腔内（G0）以及肌壁间生长（G1和G2）的肌瘤的所有宫腔镜技术。通过检索MEDLINE和EMBASE数据库，确定了1970年以来发表的论文。技术的选择主要取决于肌瘤的肌壁间延伸情况，以及个人经验和可用设备。“切除镜切片”仍然是治疗G0期肌瘤的“金标准”技术，即使已经提出了其他几种有效技术，包括钕钇铝石榴石激光消融、碎切术和门诊子宫肌瘤切除术。另一方面，本综述明确表明，对于治疗G1和G2期肌瘤，目前仍没有一种技术被证明绝对优于其他技术。大多数技术旨在将肌壁间肌瘤转变为完全位于宫腔内的病变，从而避免深切子宫肌层。目前，“冷圈套器”技术似乎是最佳选择，因为它能在一次手术中安全、完整地切除此类肌瘤，同时保护周围健康的子宫肌层。
