Kwon Yong-Soon, Roh Hyun Jin, Ahn Jun Woo, Lee Sang-Hun, Im Kyong Shil
1 Department of Obstetrics and Gynecology, College of Medicine, University of Ulsan , Ulsan University Hospital, Ulsan, Korea.
J Laparoendosc Adv Surg Tech A. 2013 Oct;23(10):866-70. doi: 10.1089/lap.2013.0248. Epub 2013 Sep 4.
To introduce the safe and effective surgical technique of laparoscopic adenomyomectomy with transient occlusion of uterine arteries (TOUA) in patients with symptomatic uterine adenomyoma.
In a prospective case study, we examined all cases of laparoscopic adenomyomectomy with TOUA performed by a single surgeon at Ulsan University Hospital, Ulsan, Korea, between May 2011 and September 2012. Surgical outcomes included operative time, intraoperative injury of blood vessels, nerves, and pelvic organs, as well as intraoperative blood loss. We assessed the degree of improvement in dysmenorrhea and menorrhagia and the recurrence of adenomyomic lesions by ultrasonography at the 6-month follow-up after laparoscopic adenomyomectomy with TOUA.
Thirty-four women who were refractory to medical treatment or who wanted surgical treatment for preserving their uterus underwent laparoscopic adenomyomectomy with TOUA using an endoscopic vascular clip. The mean age was 43.79 ± 4.94 years. The mean diameter of the adenomyomas was 5.29 ± 1.82 cm. The mean TOUA time, operation time, and hospital stay were 7.33 ± 4.12 minutes, 84.09 ± 31.48 minutes, and 3.82 ± 1.24 days, respectively. The mean estimated blood loss was 148.18 ± 93.99 mL, and no injury to the uterine arteries or pelvic nerves occurred. No cases of conversion to a laparotomy or major complications occurred. At the 6-month follow-up, complete remission of dysmenorrhea and menorrhagia occurred in 72.2% and 87.5% of patients, respectively.
Laparoscopic adenomyomectomy with TOUA could be a safe and effective surgical method for women with symptomatic uterine adenomyoma who want to preserve their fertility.
介绍对有症状的子宫腺肌病患者采用子宫动脉短暂阻断术（TOUA）进行腹腔镜下腺肌病切除术的安全有效的手术技术。
在一项前瞻性病例研究中，我们检查了2011年5月至2012年9月期间韩国蔚山大学医院一名外科医生进行的所有采用TOUA的腹腔镜腺肌病切除术病例。手术结果包括手术时间、术中血管、神经及盆腔器官损伤情况以及术中失血情况。我们在采用TOUA的腹腔镜腺肌病切除术后6个月随访时，通过超声评估痛经和月经过多的改善程度以及腺肌病病变的复发情况。
34名药物治疗无效或希望通过手术保留子宫的女性接受了使用内镜血管夹的采用TOUA的腹腔镜腺肌病切除术。平均年龄为43.79±4.94岁。腺肌瘤的平均直径为5.29±1.82厘米。TOUA的平均时间、手术时间和住院时间分别为7.33±4.12分钟、84.09±31.48分钟和3.82±1.24天。平均估计失血量为148.18±93.99毫升，未发生子宫动脉或盆腔神经损伤。无中转开腹或严重并发症发生。在6个月随访时，分别有72.2%和87.5%的患者痛经和月经过多完全缓解。
对于希望保留生育能力的有症状子宫腺肌病女性，采用TOUA的腹腔镜腺肌病切除术可能是一种安全有效的手术方法。
