[Myomectomy in nonpregnant women. Indications. Technics. Apropos of 70 cases at the Saint-Antoine's Maternity Hospital].

Seventy cases of myomectomy performed over 5 years (1977 to 1982) in the department of Gynecology & Obstetrics of the St Antoine Hospital in Paris are analyzed. During the same period, 465 patients underwent hysterectomy for leiomyoma. A brief review shows that myomectomy is not the best surgical treatment of uterine leiomyoma because of its complications. Hemorrhagy, pelvic pain and infertility remain the principle modes of discovery of uterine leiomyoma in operated patients, whose median age is fairly low. Hysterosalpingography is still the main procedure for the investigation and diagnosis of leiomyoma. However, indications of echotomography have been extended with an increase in the frequency of diagnosis of leiomyoma due to a better semiology. Primary leiomyoma section followed by excision appears preferable to conventional enucleation, which is frequently hemorrhagic and blind. In determining the indications of myomectomy, certain factors must be borne in mind: age, parity, type and insertion of leiomyoma, gynecologic history and psychological status. Good postoperative results explain the recent favor of myomectomy as the conservative surgical treatment of leiomyoma; surgical abstention, however, remains the best decision in most cases.