Department of Obstetrics and Gynecology, Jinhua Hospital of Zhejiang University, Jinhua, China.
Department of Obstetrics and Gynecology, Jinhua Hospital of Zhejiang University, Jinhua, China,
Gynecol Obstet Invest. 2019;84(6):548-554. doi: 10.1159/000499494. Epub 2019 Apr 9.
To determine the optimal hemostatic technique for laparoscopic myomectomy (LM) by comparing temporary uterine artery blockage alone or combined with blockage of the utero-ovarian vessels.
Women with symptomatic uterine myoma attending the Department of Obstetrics and Gynecology in Jinhua Municipal Central Hospital.
A total of 200 patients with symptomatic uterine fibroids were randomly divided into Group A (n = 65), Group B (n = 67) and Group C (n = 68). At the beginning of the procedure, 6 U of vasopressin was injected into the myometrium of all women. LM was performed in Group A; temporary bilateral uterine artery occlusion and myomectomy were performed in Group B and temporary bilateral uterine artery and utero-ovarian vessel occlusion was performed in Group C. We then evaluated operative time, perioperative bleeding, follow-up relief of menorrhagia, and the recurrence of fibroids.
General characteristics of the patients were similar across all 3 groups. All patients underwent successful laparoscopic operation and none of the cases needed to be converted to laparotomy; there were no intraoperative complications. There was no significant difference in the operative time between groups (p = 0.332 and p = 0.346 for single-myoma and multiple-myoma respectively), and for both single and multiple-myoma groups, the blood loss was significantly lower in Group C than Groups A and B (p < 0.001). There were no differences in the recurrence rate and menorrhagia symptom relief outcomes when -compared across the 3 groups at the 30-month follow-up (p = 0.953 and p = 0.841, respectively). At final follow-up, the pregnancy rate of the sexually active patients without contraception was not statistically significant (p = 0.958). The fertility index of anti-Mullerian hormone showed no statistical difference between groups preoperatively or at 2 days, 3 months, 6 months, and 1 year postoperatively (p = 0.998, p = 0.965, p = 0.999, p = 0.994 and p = 0.993, respectively).
LM with temporary bilateral uterine artery and utero-ovarian vessels occlusion has the advantages of less intraoperative bleeding compared with LM and laparoscopic transient uterine artery ligation and does not increase the mean operative time.
通过比较单纯子宫动脉阻断与联合阻断子宫卵巢血管两种方法，确定腹腔镜子宫肌瘤剔除术（LM）的最佳止血技术。
就诊于金华市中心医院妇产科的有症状子宫肌瘤妇女。
共 200 例有症状子宫肌瘤患者被随机分为 A 组（n = 65）、B 组（n = 67）和 C 组（n = 68）。所有妇女在手术开始时均向子宫肌层注射 6U 血管加压素。A 组行 LM；B 组行暂时性双侧子宫动脉阻断和子宫肌瘤剔除术；C 组行暂时性双侧子宫动脉和卵巢血管阻断术。然后评估手术时间、围手术期出血、随访时月经过多缓解情况以及肌瘤复发情况。
三组患者的一般特征相似。所有患者均成功完成腹腔镜手术，无一例需要转为开腹手术；术中无并发症。手术时间在各组之间无显著差异（单肌瘤和多肌瘤组分别为 p = 0.332 和 p = 0.346），且 C 组的出血量明显低于 A 组和 B 组（p < 0.001）。在 30 个月的随访中，三组之间的复发率和月经过多症状缓解结果无差异（p = 0.953 和 p = 0.841）。在最终随访时，无避孕措施的有生育能力的患者的妊娠率无统计学意义（p = 0.958）。抗苗勒管激素的生育指数在术前及术后 2 天、3 个月、6 个月和 1 年时各组间无统计学差异（p = 0.998、p = 0.965、p = 0.999、p = 0.994 和 p = 0.993）。
与 LM 和腹腔镜暂时性子宫动脉结扎相比，LM 联合暂时性双侧子宫动脉和卵巢血管阻断具有术中出血量少的优点，且不会增加平均手术时间。
