Departments of Minimally Invasive Gynaecologic Surgery (Drs Asgari, Salehi, and Hoseini) and Sonography and Radiology (Dr Abedi), Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Departments of Minimally Invasive Gynaecologic Surgery (Drs Asgari, Salehi, and Hoseini) and Sonography and Radiology (Dr Abedi), Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.
J Minim Invasive Gynecol. 2020 Jan;27(1):148-154. doi: 10.1016/j.jmig.2019.03.026. Epub 2019 Jul 10.
To evaluate uterine scar features after laparoscopic myomectomy (LM) compared with myomectomy performed by laparoscopy initially and then completed with minilaparotomy (LAM).
Prospective cohort study.
An academic center for advanced endoscopic gynecologic surgery.
Sixty-nine symptomatic women who underwent myomectomy between July and December 2018.
Patients underwent LM or LAM and 3-month follow-up ultrasonography.
Forty-four patients underwent LM and 25 underwent LAM. Demographic data, intraoperative parameters, and postoperative outcomes were collected. Two-dimensional color Doppler ultrasound was done at a 3-month follow-up to evaluate myomectomy scar features, myometrial thickness, and the presence of and vascularity of a heterogeneous mass. These features were compared with those of the intact myometrium on the opposite wall of the patient's uterus. The 2 groups had similar demographic characteristics, and there were no significant between-group differences in the number, maximum diameter, type, or location of myomas. The mean myometrial thickness at the scar site was 18.9 ± 3.22 mm in the LM group and 19.7 ± 3.50 mm in the LAM group, with no significant difference between the 2 groups. There was no meaningful difference in vascularity between the scar and normal myometrium. Heterogeneous masses were detected in 23% of patients in the LM group and in 24% of those in the LAM group. Other than mean operative time (207 minutes for LM vs 150 minutes for LAM; p < .001) and mean postoperative reduction in hemoglobin (1.77 mg/dL for LM vs 2.35 mg/dL for LAM; p = .023), there were no other statistical differences between the 2 groups. One patient in the LM group experienced a bowel injury resulting from morcellation.
There were no differences in myometrial scar features after LM compared with after LAM, implying effective suturing via both approaches.
评估腹腔镜子宫肌瘤剔除术（LM）与最初行腹腔镜手术然后完成小切口开腹手术（LAM）的子宫肌瘤剔除术后子宫瘢痕特征。
前瞻性队列研究。
高级内镜妇科手术学术中心。
2018 年 7 月至 12 月期间行子宫肌瘤剔除术的 69 例有症状妇女。
患者行 LM 或 LAM，并在术后 3 个月行超声检查。
44 例行 LM，25 例行 LAM。收集人口统计学数据、术中参数和术后结果。术后 3 个月行二维彩色多普勒超声检查，以评估子宫肌瘤剔除术后瘢痕特征、子宫肌层厚度、不均质肿块的存在和血流情况。这些特征与患者子宫对侧壁完整子宫肌层的特征进行比较。两组患者的人口统计学特征相似，肌瘤数量、最大直径、类型或位置无显著组间差异。LM 组瘢痕处子宫肌层厚度的平均值为 18.9±3.22mm，LAM 组为 19.7±3.50mm，两组间无显著差异。瘢痕与正常子宫肌层的血流无明显差异。LM 组 23%的患者和 LAM 组 24%的患者检测到不均质肿块。除手术时间（LM 组为 207 分钟，LAM 组为 150 分钟；p<0.001）和术后血红蛋白降低平均值（LM 组为 1.77mg/dL，LAM 组为 2.35mg/dL；p=0.023）外，两组间无其他统计学差异。LM 组 1 例患者发生因旋切导致的肠损伤。
LM 后与 LAM 后子宫瘢痕特征无差异，表明两种方法均能有效缝合。
