Kim Jang-Kew, Shin Chang-Soo, Ko Young-Bok, Nam Sang-Yun, Yim Hyun-Sun, Lee Ki-Hwan
Department of Obstetrics and Gynecology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
Yim Hyun Sun Obstetrics and Gynecology Clinic, Daejeon, Korea.
Obstet Gynecol Sci. 2014 Mar;57(2):128-35. doi: 10.5468/ogs.2014.57.2.128. Epub 2014 Mar 15.
The purpose of this study was to evaluate postoperative prognosis and progression in patients who received laparoscopic-assisted adenomyomectomy using the double flap method.
The pelvic cavity was explored by the conventional laparoscopic method, and drainage was achieved through a 5-mm trocar. After a small incision in the abdomen, the uterus was incised from the fundus to the upper cervical margin until exposing the endometrial cavity. Adenomyotic tissue was removed using a scalpel, scissors, or monopolar electrical bovie. The endometrial cavity was repaired with interrupted sutures using 2-0 vicryl. One side of the serosal flap was used to cover the endometrial side of the uterus. The second serosal flap covered the first flap after removal of the serosal surface of the first flap.
From January 2008 to March 2012, there were 11 cases of laparoscopic-assisted adenomyomectomy at Chungnam National University Hospital. Nine cases were analyzed, excluding two cases with less than one year of follow-up. The average patient age was 37.0 years and average follow-up duration was 32.8 months. All patients showed improvement in dysmenorrhea (P < 0.001) and hypermenorrhea (P = 0.001) after surgery and were evaluated by visual analogue scale score. However, symptoms of adenomyosis were aggravated in three patients. Adenomyosis was progressed in the side opposite the site of operation. One patient required a total laparoscopic hysterectomy 27 months after surgery.
Laparoscopic-assisted adenomyomectomy using the double flap method is effective for uterine reduction and relief of dysmenorrhea and hypermenorrhea. Conservative management and careful follow-up are needed because adenomyosis can recur or progress in some patients.
本研究旨在评估采用双瓣法行腹腔镜辅助子宫腺肌病切除术患者的术后预后及病情进展情况。
采用传统腹腔镜方法探查盆腔，通过一个5毫米的套管针进行引流。在腹部做一个小切口后，从子宫底部至宫颈上缘切开子宫，直至暴露子宫内膜腔。使用手术刀、剪刀或单极电刀切除子宫腺肌病组织。用2-0可吸收缝线间断缝合修复子宫内膜腔。将一侧浆膜瓣用于覆盖子宫的内膜面。在切除第一瓣的浆膜面后，第二瓣浆膜覆盖第一瓣。
2008年1月至2012年3月，忠南国立大学医院共进行了11例腹腔镜辅助子宫腺肌病切除术。排除2例随访时间不足一年的病例后，对9例进行了分析。患者平均年龄为37.0岁，平均随访时间为32.8个月。所有患者术后痛经（P < 0.001）和月经过多（P = 0.001）均有改善，并通过视觉模拟评分法进行评估。然而，有3例患者子宫腺肌病症状加重。子宫腺肌病在手术部位对侧进展。1例患者在术后27个月需要行全腹腔镜子宫切除术。
采用双瓣法行腹腔镜辅助子宫腺肌病切除术对于子宫缩小及缓解痛经和月经过多有效。由于部分患者子宫腺肌病可能复发或进展，因此需要进行保守治疗并仔细随访。
