Cezar Cristina, Becker Sven, di Spiezio Sardo Attilio, Herrmann Anja, Larbig Angelika, Tanos Vasilis, de la Roche Luz Angela Torres, Verhoeven Hugo Christian, Wallwiener Markus, De Wilde Rudy Leon
Clinic for Gynecology and Obstetrics of Carl von Ossietzky University Medical School, Oldenburg, Germany.
Clinic of Gynecology and Obstetrics at University Clinic Frankfurt, Frankfurt, Germany.
Arch Gynecol Obstet. 2017 Oct;296(4):709-720. doi: 10.1007/s00404-017-4490-x. Epub 2017 Aug 17.
Uterine myomas are the main cause of benign uterine diseases in premenopausal women. Objective of the present paper is to investigate the current best treatment modalities of myomas, depending on age of the patient and her desire to preserve fertility, as well as on clinical presentation of this pathology, such as size, number, and location of fibroids and, furthermore, on surgical experience of the gynecologist.
The design of our work is a systematic literature review of existing studies, reviews, and meta-analysis conducted in PubMed and Cochrane Library to identify relevant literature. Commonly, the myomectomy is to be recommended in women desiring to preserve fertility when myomas are associated with symptoms such as excessive bleeding, pelvic discomfort, or palpable abdominally fibroids. The decision of surgical approach for myomectomy should be individualized, depending on size and location, as well as on surgeon's experience. The different modalities of myomectomy, laparoscopic, hysteroscopic, robotic-assisted, or laparotomic are in detail presented in the paper, according to Society of Obstetricians and Gynecologists of Canada (SOGC) clinical practice guidelines and taking into consideration possible concerns of myomectomy such as uterine rupture, development of adhesions, and myomas' recurrence.
子宫肌瘤是绝经前女性良性子宫疾病的主要原因。本文的目的是根据患者年龄、保留生育能力的意愿、该病理的临床表现（如肌瘤的大小、数量和位置）以及妇科医生的手术经验，探讨目前子宫肌瘤的最佳治疗方式。
我们的研究设计是对在PubMed和Cochrane图书馆进行的现有研究、综述和荟萃分析进行系统的文献回顾，以识别相关文献。通常，当肌瘤伴有月经过多、盆腔不适或腹部可触及肌瘤等症状时，对于希望保留生育能力的女性，建议行肌瘤切除术。肌瘤切除术的手术方式应根据肌瘤大小、位置以及外科医生的经验进行个体化选择。本文根据加拿大妇产科医师协会（SOGC）临床实践指南，并考虑到肌瘤切除术可能存在的问题，如子宫破裂、粘连形成和肌瘤复发，详细介绍了不同的肌瘤切除方式，包括腹腔镜、宫腔镜、机器人辅助或开腹手术。
