Takeda Satoru, Ota Tsuyoshi, Kaneda Hiroshi, Terao Yasuhisa, Kuwatsuru Ryohei
Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Tokyo, Japan.
Department of Radiology, Faculty of Medicine, Juntendo University, Tokyo, Japan.
Surg J (N Y). 2019 Aug 5;6(Suppl 1):S11-S21. doi: 10.1055/s-0039-1693041. eCollection 2020 May.
Abdominal myomectomy for a huge myomas, especially uterine cervical myoma, is difficult because of risks, such as intraoperative bleeding or injury to adjacent organs. Therefore, understanding of the positional relationships among a huge myoma, especially cervical or intraligamental myoma, and the vascular plexuses in the right and left cardinal ligaments is important for prevention of massive bleeding during myomectomy. While sufficiently performing preoperative assessment with pelvic examination, ultrasonography, magnetic resonance imaging (MRI), etc., surgeons should always keep in mind how they can reduce the blood loss volume, while safely and surely performing resections. For a cervical myoma of the uterus and giant uterine leiomyoma that leave no intrapelvic space and prevent palpation and identification of the uterine arteries and the internal iliac arteries, surgery can be performed safely by preoperatively placing balloon catheters in the internal iliac arteries. Hemostaic strategies for myomectomy and tips of subsequent pregnancy following myomectomy are also described.
对于巨大肌瘤，尤其是子宫颈肌瘤，行腹部肌瘤切除术因存在术中出血或邻近器官损伤等风险而具有难度。因此，了解巨大肌瘤，尤其是宫颈或阔韧带内肌瘤与左右主韧带血管丛之间的位置关系，对于预防肌瘤切除术中大出血至关重要。在通过盆腔检查、超声、磁共振成像（MRI）等充分进行术前评估时，外科医生应始终牢记如何在安全、确切地进行切除的同时减少失血量。对于不留盆腔空间、妨碍触诊和识别子宫动脉及髂内动脉的子宫颈肌瘤和巨大子宫平滑肌瘤，可通过术前在髂内动脉放置球囊导管来安全地进行手术。本文还介绍了肌瘤切除术的止血策略以及肌瘤切除术后后续妊娠的要点。
