Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea.
Department of Obstetrics and Gynecology, University of Inje College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea.
Taiwan J Obstet Gynecol. 2021 Nov;60(6):1005-1010. doi: 10.1016/j.tjog.2021.09.010.
The present study assessed the safety and benefits of laparoscopic-assisted adenomyomectomy compared to laparoscopic or laparotomic adenomyomectomy.
This study was a retrospective comparative study. A total of 277 patients underwent adenomyomectomy between January 2016 and January 2019 at the Department of Obstetrics and Gynaecology, Ulsan University Hospital, including 25 with laparoscopic-assisted adenomyomectomy, 82 with laparoscopic adenomyomectomy, and 170 with laparotomic adenomyomectomy. Laparoscopic-assisted adenomyomectomy consisted of a laparoscopic uterine artery procedure to reduce blood loss and a minimal incisional for laparotomic adenomyomectomy. An additional laparoscopic surgery was performed for possible pelvic pathology.
Data on patient demographics, surgical indications, operative times, estimated blood loss (EBL), short-term complications, and postoperative hospital stays were compared. The laparoscopic-assisted surgery (LAS) and laparotomic groups were comparable in average EBL (208.0 ± 128.8 vs. 193.6 ± 193.0 ml, p = 0.11), weight of removed mass (85.5 ± 71.7 vs. 108.2 ± 91.9 g, p = 0.39), and postoperative hospital days (HDs) (4.5 ± 1.0 vs. 4.7 ± 0.8 days, p = 0.27). These values were lower in the laparoscopic group (EBL 119.5 ± 79.6 ml, mass weight 39.3 ± 25.9 g, HD 3.6 ± 0.8 days). Additional procedures, including myomectomy and combined severe endometriosis surgery, were more frequently performed in the LAS group than the laparotomic group. The mean operating time was longer in the LAS group (179.8 ± 36.6 min) than the other groups (laparoscopy 99.9 ± 40.6 min, p < 0.00; laparotomy 133.0 ± 41.1 min, p < 0.00). The three groups did not differ significantly in transfusion rates, hemoglobin changes, or perioperative complications. However, febrile morbidity was lower in the laparoscopic group than the LAS and laparotomic groups.
LAS adenomyomectomy allows for maximal debulking of adenomyosis via extracorporeal and intracorporeal procedures while retaining the advantages of the laparoscopic approach. Additional pelvic surgery for benign uterine and adnexal pathology may easily be performed with this approach.
本研究评估了与腹腔镜或剖腹手术相比，腹腔镜辅助子宫肌瘤切除术的安全性和益处。
这是一项回顾性对比研究。2016 年 1 月至 2019 年 1 月，共有 277 名患者在蔚山大学医院妇产科接受了子宫肌瘤切除术，其中 25 名患者接受了腹腔镜辅助子宫肌瘤切除术，82 名患者接受了腹腔镜子宫肌瘤切除术，170 名患者接受了剖腹子宫肌瘤切除术。腹腔镜辅助子宫肌瘤切除术包括腹腔镜子宫动脉手术以减少出血量和最小切口的剖腹子宫肌瘤切除术。为了可能的盆腔病理情况，还进行了额外的腹腔镜手术。
比较了患者人口统计学、手术指征、手术时间、估计出血量（EBL）、短期并发症和术后住院时间。腹腔镜辅助手术（LAS）组和剖腹组的平均 EBL（208.0±128.8 vs. 193.6±193.0 ml，p=0.11）、切除组织重量（85.5±71.7 vs. 108.2±91.9 g，p=0.39）和术后住院天数（4.5±1.0 vs. 4.7±0.8 天，p=0.27）相似。腹腔镜组的这些值较低（EBL 119.5±79.6 ml，组织重量 39.3±25.9 g，住院天数 3.6±0.8 天）。LAS 组比剖腹组更常进行附加手术，包括子宫肌瘤切除术和联合严重子宫内膜异位症手术。LAS 组的平均手术时间（179.8±36.6 分钟）长于其他组（腹腔镜 99.9±40.6 分钟，p<0.00；剖腹 133.0±41.1 分钟，p<0.00）。三组在输血率、血红蛋白变化或围手术期并发症方面无显著差异。然而，腹腔镜组的发热发病率低于 LAS 组和剖腹组。
腹腔镜辅助子宫肌瘤切除术允许通过体外和体内手术最大限度地切除子宫腺肌病，同时保留腹腔镜手术的优势。对于良性子宫和附件疾病的附加盆腔手术，很容易通过这种方法进行。
