Service of Obstetrics and Gynecology, Hospital Universitari Parc de Salut Mar, Auniversitat Autònoma de Barcelona, Barcelona, Spain.
Eur J Obstet Gynecol Reprod Biol. 2013 Jun;168(2):191-4. doi: 10.1016/j.ejogrb.2013.01.002. Epub 2013 Jan 31.
To assess the feasibility of a new two-step technique for office hysteroscopic resection of submucous myomas.
Between January 2010 and December 2011, all consecutive patients of reproductive age with symptomatic lesions sonographically diagnosed as single mainly intracavitary (G1 or G2) myoma ≤4.0 cm were eligible to participate in a prospective study. They underwent a two-step hysteroscopic procedure, which included preparation of partially intramural myomas with incision of the endometrial mucosa and the pseudocapsule covering the myoma in the first step, and excision of the myoma by means of diode laser four weeks later. All procedures were performed on an outpatient basis and without anesthesia.
A total of 43 women (mean age 36.7 years) were included. The two-step myomectomy technique was successfully performed in 34 (79.1%) patients. All myomas ≤18 mm were successfully enucleated as compared with 85% of 19-30 mm, and 0% of ≥30 mm (P<0.001). Also, myomas located in the anterior/posterior walls and those located in the fundus/lateral walls were enucleated in 87.9% and 50% of cases, respectively (P=0.020). Success of surgery was not influenced by the initial type of myoma.
The new two-step hysteroscopic myomectomy carried out as an outpatient procedure and without anesthesia is feasible for the excision of symptomatic submucous fibroids.
评估一种新的两步式技术用于经阴道子宫镜下黏膜下肌瘤切除术的可行性。
2010 年 1 月至 2011 年 12 月，所有符合条件的连续生殖年龄患者均因症状性病变超声诊断为单发主要腔内（G1 或 G2）肌瘤≤4.0cm 而有资格参加前瞻性研究。他们接受了两步式宫腔镜手术，包括在第一步中准备部分壁内肌瘤，切开子宫内膜黏膜和覆盖肌瘤的假包膜，以及四周后用二极管激光切除肌瘤。所有手术均在门诊进行，无需麻醉。
共有 43 名妇女（平均年龄 36.7 岁）被纳入研究。34 名（79.1%）患者成功完成了两步式肌瘤切除术。所有≤18mm 的肌瘤均成功切除，而 19-30mm 的肌瘤切除成功率为 85%，≥30mm 的肌瘤切除成功率为 0%（P<0.001）。此外，前壁/后壁肌瘤和底部/侧壁肌瘤的切除成功率分别为 87.9%和 50%（P=0.020）。手术成功率不受肌瘤初始类型的影响。
新的两步式经阴道子宫镜下肌瘤切除术作为一种门诊手术且无需麻醉，对于切除有症状的黏膜下肌瘤是可行的。
