Division of Experimental Researches on Endoscopic Surgery, Imaging, Minimally Invasive Therapy & Technology, Department of Obstetrics and Gynecology, Vito Fazzi Hospital, P.zza Muratore, 73100 Lecce, Italy.
Hum Reprod. 2012 Sep;27(9):2664-70. doi: 10.1093/humrep/des212. Epub 2012 Jun 14.
Can uterine scar healing after laparoscopic intracapsular myomectomy (LIM) be adequately monitored by traditional two-dimensional (2D) ultrasound (US) and Doppler velocimetry?
The myometrial area of the scar after LIM can be followed by 2D US and Doppler velocimetry.
Apart from post-surgical adhesions, the main concern linked to laparoscopic myomectomy is the quality of healing of the myometrial incision: it has been suggested that US could be useful for assessing uterine scars after myomectomy. However, no diagnostic method has yet been widely accepted to assess the healing process.
STUDY DESIGN, SIZE, DURATION: A cohort prospective study (level of evidence II-2), run in University-affiliated hospitals: 149 women with symptomatic uterine fibroids (UFs) underwent LIM, between January 2007 and October 2011. During follow up 13 patients withdrew from the study.
PARTICIPANTS/MATERIALS, SETTING, METHODS: After LIM, all patients were followed by traditional 2D US scanning and Doppler velocimetry on Days: 0, 1, 7, 30 and 45. Authors evaluated: number, size and location of UFs, scar diameter and Doppler velocimetry and resistance index (RI) of the uterine arteries, at their ascending branch.
The uterine examination showed a significant (P < 0.05) progressive reduction of uterine scar area from 78% of the previous UF location on the first day, to 19% on 30th day, and <4% on the 45th day. There was no correlation with the size of the fibroid or the relative reduction in the size of the scar, on both Days 1 and 45. There was a significant (P < 0.05) increase in the RI of the ipsilateral uterine arteries from 0.65 on the first post-operative day to 0.83 after 7 days followed by a decrease to 0.71 on the 30th and 0.61 on the 45th post-operative day.
LIMITATIONS, REASONS FOR CAUTION: This is a cohort investigation on a limited number of patients and it does not surgically compare LIM and 'classic' myomectomy in the scar US follow up.
LIM avoided intraoperative bleeding and excessive tissue damage, as post-operative US follow up showed, with just two intra-myometrial hematomas (1.5%). The 2D US and Doppler velocimetry, a non-invasive safe method to check the myometrium after LIM, can detect post-operative hematoma and disechogenic, heterogeneous or ill-defined scar area, all unfavorable signs for myometrial scarring. Moreover, Doppler transvaginal monitoring, evaluating the pulsatility index (PI) and RI of the uterine arteries at their ascending branch, could identify patients with altered PI and RI parameters, possible markers of impaired wound healing.
腹腔镜囊内子宫肌瘤切除术（LIM）后子宫瘢痕愈合情况能否通过传统二维（2D）超声（US）和多普勒速度计充分监测？
LIM 后，瘢痕的子宫肌层可以通过 2D US 和多普勒速度计进行监测。
除术后粘连外，与腹腔镜子宫肌瘤切除术相关的主要问题是子宫切口愈合的质量：有人提出，超声可能有助于评估子宫肌瘤切除术后的子宫疤痕。然而，还没有一种被广泛接受的诊断方法来评估愈合过程。
研究设计、大小、持续时间：一项在大学附属医院进行的队列前瞻性研究（证据水平 II-2）：2007 年 1 月至 2011 年 10 月，149 名有症状的子宫肌瘤（UFs）患者接受了 LIM。在随访期间，有 13 名患者退出了研究。
参与者/材料、地点、方法：在 LIM 后，所有患者在术后第 0、1、7、30 和 45 天通过传统的 2D US 扫描和多普勒速度计进行随访。作者评估了：UF 的数量、大小和位置、瘢痕直径和子宫动脉的多普勒速度计和阻力指数（RI），在其上升支。
子宫检查显示，子宫瘢痕面积从第一天的前 UF 位置的 78%显著（P <0.05）减少到第 30 天的 19%，第 45 天的<4%。第 1 天和第 45 天，瘢痕大小与肌瘤大小或瘢痕相对缩小均无相关性。同侧子宫动脉的 RI 从术后第 1 天的 0.65 显著（P <0.05）增加到第 7 天的 0.83，然后在第 30 天和第 45 天下降至 0.71 和 0.61。
局限性、谨慎的原因：这是一项对有限数量患者的队列研究，并没有对 LIM 和“经典”子宫肌瘤切除术在瘢痕 US 随访中的效果进行手术比较。
LIM 避免了术中出血和过度组织损伤，正如术后 US 随访所示，只有两个子宫肌内血肿（1.5%）。2D US 和多普勒速度计是一种非侵入性的安全方法，可以检查 LIM 后的子宫肌层，可以检测术后血肿和回声不均、不均匀或边界不清的瘢痕区域，所有这些都是不利于子宫瘢痕形成的迹象。此外，经阴道多普勒监测，评估上升支子宫动脉的搏动指数（PI）和 RI，可识别 PI 和 RI 参数改变的患者，这些可能是伤口愈合受损的标志物。
