Yoong Wai, Zhao Wei, Cai Hong, D'Cruz Robyn, Corrieri Alessia, Hamilton John, Fakokunde Abiodun
Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, United Kingdom.
The Affiliated Women's Hospital School of Medicine, Zhejiang University, Hangzhou, China.
J Minim Invasive Gynecol. 2017 Jul-Aug;24(5):811-814. doi: 10.1016/j.jmig.2017.04.002. Epub 2017 Apr 12.
To examine demographics and outcome measures of women having undergone vaginal excision of myomas through the Dührssen (longitudinal median cervical) incision.
Prospective case series (Canadian Task Force classification II-3).
A London teaching hospital.
Nineteen patients with either a submucous myoma (type 1) located near the cervix or a pedunculated intracavity myoma (type 0), excised via the Dührssen incision.
Dührssen (median longitudinal) incision on the anterior or posterior cervical lip.
Duration of procedures, intraoperative complications, estimated blood loss, length of stay, percent of patients discharged in 24 hours, and readmission rates were studied. Between 2009 and 2016, 19 women had their myomas (submucous type 1, n = 17; pedunculated intracavity type 0, n = 2) removed vaginally with the Dührssen incision. The median age at time of procedure was 46 years (range, 43-55), and the most common indication was menorrhagia, which occurred in 90% of cases. The median myoma size was 7 cm (range, 6-9), whereas the median duration of surgery was 60 minutes (range, 40-120). Anterior cervical incisions were performed in 60% of cases, and 20% of the patients received gonadotropins for medical debulking of the myomas before surgery. One patient sustained a bladder injury that occurred when making the anterior cervical incision. The median length of stay was 8 hours (range, 6-36) and the median estimated blood loss was 90 mL (range, 50-150). The median duration of follow-up was 4 years (range, .5-6), and no patients had symptoms that were attributable to the procedure.
This is a useful technique that complements a minimally invasive surgeon's repertoire and is a viable alternative when hysteroscopic myomectomy is deemed unsuitable because of location and size of the myomas.
探讨经迪尔森（纵向宫颈正中）切口行子宫肌瘤阴道切除术的女性的人口统计学特征及结局指标。
前瞻性病例系列研究（加拿大工作组分类II - 3）。
伦敦一家教学医院。
19例患有位于宫颈附近的黏膜下肌瘤（1型）或有蒂的宫腔内肌瘤（0型）的患者，经迪尔森切口切除肌瘤。
在宫颈前唇或后唇做迪尔森（纵向正中）切口。
研究手术时间、术中并发症、估计失血量、住院时间、24小时内出院患者百分比及再入院率。2009年至2016年期间，19例女性经迪尔森切口行阴道肌瘤切除术（黏膜下1型肌瘤17例，有蒂宫腔内0型肌瘤2例）。手术时的中位年龄为46岁（范围43 - 55岁），最常见的指征是月经过多，90%的病例出现该情况。肌瘤中位大小为7 cm（范围6 - 9 cm），而中位手术时间为60分钟（范围40 - 120分钟）。60%的病例采用宫颈前切口，20%的患者在手术前接受促性腺激素以缩小肌瘤体积。1例患者在做宫颈前切口时发生膀胱损伤。中位住院时间为8小时（范围6 - 36小时），中位估计失血量为90 mL（范围50 - 150 mL）。中位随访时间为4年（范围0.5 - 6年），无患者出现与手术相关的症状。
这是一项有用的技术，可补充微创外科医生的技术储备，当因肌瘤的位置和大小而认为宫腔镜子宫肌瘤切除术不适合时，是一种可行的替代方法。
