Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan.
Taiwan J Obstet Gynecol. 2009 Dec;48(4):335-41. doi: 10.1016/S1028-4559(09)60321-1.
Since the initial description of laparoscopic myomectomy (LM) in 1979, many reports of this technique have been published worldwide. The indications for LM have grown in line with improvements in laparoscopic techniques and instruments over the last decade. LM offers several benefits to patients but remains a challenging technical procedure that is associated with high surgical morbidity and a high incidence of blood transfusion. LM procedures include excision of the myoma(s), repair of myometrium, and removal of the myoma from the abdomen. The control of operative blood loss is crucial, especially in the case of large intramural fibroids. Different studies have found wide variations in the incidence of recurrence after LM. Ultrasound imaging and Doppler velocimetry can be used to assess uterine scars after LM. Uterine rupture during pregnancy is a serious concern after LM, and all published cases report the occurrence of rupture before the start of labor. Surgical strategies are needed to overcome these problems associated with LM. Although LM is minimally invasive in terms of the wound, it remains an advanced and invasive procedure. An appropriate management strategy is required for each patient, and careful discussion and counseling regarding all the issues are necessary.
自 1979 年首次描述腹腔镜子宫肌瘤切除术（LM）以来，全世界已经发表了许多关于该技术的报告。随着过去十年腹腔镜技术和器械的不断改进，LM 的适应证也在不断扩大。LM 为患者带来了诸多益处，但仍然是一项具有挑战性的技术操作，与高手术发病率和高输血率相关。LM 手术包括切除肌瘤、修复子宫肌层和从腹部取出肌瘤。控制手术失血量至关重要，尤其是对于大型壁间肌瘤。不同的研究发现，LM 后肌瘤复发的发生率存在很大差异。超声成像和多普勒速度计可用于评估 LM 后的子宫疤痕。LM 后妊娠子宫破裂是一个严重的问题，所有已发表的病例均报告在分娩开始前发生破裂。需要采取手术策略来克服与 LM 相关的这些问题。尽管从伤口方面来看，LM 是微创的，但它仍然是一种先进的有创性手术。需要为每位患者制定适当的管理策略，并就所有问题进行仔细的讨论和咨询。
