Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
Fertil Steril. 2020 Dec;114(6):1352-1354. doi: 10.1016/j.fertnstert.2020.07.032. Epub 2020 Sep 14.
To demonstrate an innovative idea for a four-petal method for performing laparoscopic adenomyomectomy on a patient with focal-type adenomyosis.
A step-by-step explanation of the technique with narrated video footage.
University hospital.
PATIENT(S): A 38-year-old female with a 7 × 4 cm adenomyoma at the anterior uterine wall.
INTERVENTION(S): Laparoscopic adenomyomectomy began with a cruciate incision to turn the adenomyoma into the shape of a blooming four-petal flower to fully expose the tumor and maximize the removal of adenomyotic tissue. During excision of the lesion, around a 1 cm thickness of the myometrium was preserved at the subendometrial region and around a 0.5 cm thickness of the serosa flap was also left in each "petal." Suture repair in the method introduced is different from closing the wound by approximation of myometrium to myometrium as in traditional myomectomy; instead, herein we repaired the adenomyomectomy wound by anchoring the serosal flap to the subendometrial tissue, with care taken to avoid dead space.
MAIN OUTCOME MEASURE(S): Subjective clinical symptoms as well as serial ultrasonographic measurement of the uterine size, shape, and wall thickness.
RESULT(S): The specimen removed was 92 g in weight. The symptoms have dramatically decreased since the procedure and dysmenorrhea improved from visual analog scale 8 to 1 postoperatively. Besides achieving satisfactory symptomatic relief, the ultrasonographic measurement of the myometrium was of adequate thickness (2.3 cm) after the operation and did not increase in a serial follow-up of 33 months.
CONCLUSION(S): The four-petal method of adenomyomectomy with cruciate incision offers full exposure to the localized adenomyosis. It greatly facilitates a balance between the maximized resection of the lesions and tailored reserves of myometrium. Subsequent repair by anchoring the serosal flap to the subendometrial tissue ensures adequate thickness of the uterine wall after the operation.
展示一种针对局灶型子宫腺肌病患者进行腹腔镜腺肌瘤切除术的四瓣法创新理念。
分步说明技术并配以解说视频。
大学医院。
一名 38 岁女性，前壁子宫有一个 7×4cm 的腺肌瘤。
腹腔镜腺肌瘤切除术始于十字形切口，将腺肌瘤转变成盛开的四瓣花状，充分暴露肿瘤并最大限度切除腺肌组织。在切除病灶时，在子宫内膜下区域保留约 1cm 厚的子宫肌层，并且在每个“花瓣”中也留下 0.5cm 厚的浆膜瓣。本研究中介绍的缝合修复方法与传统子宫肌瘤切除术中通过子宫肌层对合来关闭伤口不同；相反，我们通过将浆膜瓣固定到子宫内膜下组织来修复腺肌瘤切除术的伤口，注意避免死腔。
主观临床症状以及子宫大小、形状和壁厚度的连续超声测量。
切除的标本重 92g。手术后症状明显减轻，痛经从视觉模拟评分 8 分改善至 1 分。除了获得满意的症状缓解外，手术后子宫肌层的超声测量值足够厚（2.3cm），并且在 33 个月的连续随访中没有增加。
十字形切口的四瓣法腺肌瘤切除术提供了对局限性子宫腺肌病的充分暴露。它极大地促进了病变的最大切除和有针对性的子宫肌层保留之间的平衡。随后通过将浆膜瓣固定到子宫内膜下组织来进行修复，可确保手术后子宫壁的厚度足够。
