Prapas Yannis, Kalogiannidis Ioannis, Prapas Nikos
Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, and the Iakentro Fertility Center, Thessaloniki, Greece.
Am J Obstet Gynecol. 2009 Feb;200(2):144.e1-6. doi: 10.1016/j.ajog.2008.08.063. Epub 2008 Nov 18.
This study was undertaken to compare the intraoperative and short-term outcomes between the 2 modalities of minimally invasive surgery for the management of uterine fibroids.
A total of 116 patients with inclusion criteria were prospectively collected in a study period from March 1997 through 2007. Laparoscopic (n = 40) vs laparoscopically assisted myomectomy (n = 76) were compared for the management of no more than 3 intramural or subserous uterine myomas, of a maximum diameter of 90 mm.
The patients' characteristics by age, parity, body mass index, number and location of myomas were well balanced between the 2 study groups. The mean diameter of the myomas was the only characteristic significantly higher in the laparoscopically assisted myomectomy group. The operative time in the laparoscopically assisted myomectomy was significantly shorter compared with the laparoscopic myomectomy (mean +/- standard deviation: 66 +/- 19 minutes vs 94 +/- 18 minutes, P < .0001). A shorter uterine incision was found in the laparoscopically assisted myomectomy technique compared with the laparoscopic myomectomy (2.9 +/- 0.6 vs 4.3 +/- 1.2, P < .0001). Estimated blood loss was significantly higher in the laparoscopically assisted myomectomy group (P = .002). Intraoperative, early postoperative complications, hospitalization days, and fully returned activity were similar between the 2 study groups.
The present data suggest that the laparoscopically assisted myomectomy is a valid alternative to laparoscopy in a setting of minimally invasive surgery for the management of uterine fibroids.
本研究旨在比较两种子宫肌瘤微创手术方式的术中及短期疗效。
在1997年3月至2007年的研究期间，前瞻性收集了116例符合纳入标准的患者。比较腹腔镜子宫肌瘤切除术（n = 40）与腹腔镜辅助子宫肌瘤切除术（n = 76）治疗不超过3个肌壁间或浆膜下子宫肌瘤（最大直径90 mm）的情况。
两组研究对象在年龄、产次、体重指数、肌瘤数量和位置等方面特征均衡。肌瘤平均直径是腹腔镜辅助子宫肌瘤切除术组唯一显著更高的特征。腹腔镜辅助子宫肌瘤切除术的手术时间明显短于腹腔镜子宫肌瘤切除术（均值±标准差：66±19分钟 vs 94±18分钟，P <.0001）。与腹腔镜子宫肌瘤切除术相比，腹腔镜辅助子宫肌瘤切除术技术的子宫切口更短（2.9±0.6 vs 4.3±1.2，P <.0001）。腹腔镜辅助子宫肌瘤切除术组的估计失血量明显更高（P =.002）。两组研究对象在术中、术后早期并发症、住院天数和完全恢复活动方面相似。
目前的数据表明，在子宫肌瘤微创手术中，腹腔镜辅助子宫肌瘤切除术是腹腔镜手术的有效替代方法。
