Tinelli Andrea, Mynbaev Ospan A, Sparic Radmila, Vergara Daniele, Di Tommaso Silvia, Salzet Michel, Maffia Michele, Malvasi Antonio
Department of Gynecology and Obstetrics, Division of Experimental Endoscopic Surgery, Imaging, Minimally Invasive Therapy and Technology, Vito Fazzi Hospital, Lecce, Italy.
Curr Protein Pept Sci. 2017;18(2):129-139. doi: 10.2174/1389203717666160322150338.
Fibroids or myomas involve large proportion of women of reproductive age. The myoma formation starts from the transformation of the myometrium, causing the progressive formation of a pseudocapsule, which is made of compressed muscle fibers. Numerous studies investigated on myoma pseudocapsule anatomy, discovering many neurotransmitters and neuropeptides, as a neurovascular bundle, influencing myometrial physiology. These substances have a positive impact on wound healing and muscular restoring, also playing a role in sexual and reproductive function. Based on investigations, a distinct surgical technique evolved, called "intracapsular myomectomy", meaning myoma removal from its pseudocapsule, which enables protection of the myoma pseudocapsule, containing neuropeptides and neurofibers involved in physiological myometrial healing. This technique, performed by a gentle myoma enucleating by stretching from myometrium and sparing pseudocapsule, reduces surgical trauma caused by iatrogenic myoma pseudocapsule damage. Intracapsular myomectomy meets the basic surgical anatomy principle: myoma is removed by a bloodless, precise and careful dissection sparing myometrium, as much as possible. The rationale of intracapsular myomectomy should be applied to all myoma removals; therefore, it has been used for both laparoscopic and laparotomic myomectomy, as well as for cesarean myomectomy. Scientific research is still seeks to clarify some reports of myomas with infertility, especially in the case of intramural myomas, but it is clear that in the case of performing myomectomy, it must do by the described intracapsular technique. This enables myometrial preservation, especially peripherally to myoma bed, promoting myometrial healing after myoma removal.
子宫肌瘤在育龄女性中颇为常见。肌瘤的形成始于子宫肌层的转变，促使由受压肌纤维构成的假包膜逐渐形成。众多研究对肌瘤假包膜的解剖结构进行了探究，发现了许多作为神经血管束的神经递质和神经肽，它们会影响子宫肌层的生理功能。这些物质对伤口愈合和肌肉恢复有积极作用，在性功能和生殖功能中也发挥着作用。基于这些研究，一种独特的手术技术应运而生，即“包膜内子宫肌瘤切除术”，也就是从假包膜中切除肌瘤，这样能够保护含有参与子宫肌层生理性愈合的神经肽和神经纤维的肌瘤假包膜。该技术通过轻柔地从子宫肌层拉伸并保留假包膜来摘除肌瘤，减少了因医源性损伤肌瘤假包膜而导致的手术创伤。包膜内子宫肌瘤切除术符合基本的手术解剖学原则：通过无血、精确且小心的解剖尽可能保留子宫肌层来切除肌瘤。包膜内子宫肌瘤切除术的原理应适用于所有肌瘤切除手术；因此，它已被用于腹腔镜和开腹子宫肌瘤切除术，以及剖宫产时的肌瘤切除术。科学研究仍在努力阐明一些关于肌瘤与不孕关系的报道，尤其是壁间肌瘤的情况，但很明显，在进行肌瘤切除手术时，必须采用上述包膜内技术。这能够保留子宫肌层，特别是在肌瘤床周边，促进肌瘤切除术后子宫肌层的愈合。
