Friedman Jaclyn A, Wong Jacqueline M K, Chaudhari Angela, Tsai Susan, Milad Magdy P
Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
Curr Opin Obstet Gynecol. 2018 Aug;30(4):243-251. doi: 10.1097/GCO.0000000000000475.
Submucosal uterine leiomyomas are a common benign pelvic tumor that can cause abnormal uterine bleeding and may contribute to infertility and miscarriage. Hysteroscopic myomectomy is the treatment of choice to alleviate bleeding from these myomas and to normalize the uterine cavity. This review discusses the techniques and recent evidence for hysteroscopic myomectomy and examines the two primary surgical tools employed today: the bipolar resectoscope and hysteroscopic mechanical morcellator.
Hysteroscopic myomectomy has been a popular treatment for symptomatic submucosal fibroids for decades; it is a minimally invasive, low-cost, low-risk procedure, and is associated with high patient satisfaction. There have been rapid advances in the surgical technology available for this procedure. Both the bipolar resectoscope and the hysteroscopic mechanical morcellator are appropriate tools to remove submucosal myomas. Although the hysteroscopic morcellators have been associated with shortened operative time and a decreased learning curve, the data are limited for their use on type 2 fibroids. The strength of the bipolar resectoscope lies in its ability to resect deeper type 2 fibroids.
The evidence suggests that no one technique should be used for all patients, but rather a choice of technique should be taken on a case-by-case basis, depending on the myoma number, size, type, and location. Gynecologists must become knowledgeable about each of these techniques and their associated risks to safely offer these surgeries to their patients.
黏膜下子宫肌瘤是一种常见的盆腔良性肿瘤，可导致异常子宫出血，并可能导致不孕和流产。宫腔镜子宫肌瘤切除术是缓解这些肌瘤引起的出血并使子宫腔恢复正常的首选治疗方法。本综述讨论了宫腔镜子宫肌瘤切除术的技术和最新证据，并审视了当今使用的两种主要手术工具：双极电切镜和宫腔镜机械粉碎器。
几十年来，宫腔镜子宫肌瘤切除术一直是治疗有症状黏膜下肌瘤的常用方法；它是一种微创、低成本、低风险的手术，患者满意度高。用于该手术的外科技术有了快速进展。双极电切镜和宫腔镜机械粉碎器都是切除黏膜下肌瘤的合适工具。虽然宫腔镜粉碎器与缩短手术时间和降低学习曲线相关，但关于其用于2型肌瘤的数据有限。双极电切镜的优势在于其能够切除更深的2型肌瘤。
证据表明，不应对所有患者使用同一种技术，而应根据肌瘤的数量、大小、类型和位置，逐案选择技术。妇科医生必须了解每种技术及其相关风险，以便安全地为患者提供这些手术。
