Nezhat C, Nezhat F, Bess O, Nezhat C H, Mashiach R
Center for Special Pelvic Surgery, Atlanta, Georgia.
Int J Fertil Menopausal Stud. 1994 Jan-Feb;39(1):39-44.
This study was undertaken to assess the efficacy of a combined operative laparoscopy and minilaparotomy technique to remove single and multiple large leiomyomas.
Laparoscopy was used to treat associated pelvic pathology, to identify the leiomyoma(s) and bring it to a minilaparotomy incision and to remove by irrigation blood clots and debris at the end of the procedure. Through this incision, the leiomyoma(s) is grasped, shelled, morcellated, and the uterine defect is repaired in layers.
We retrospectively evaluated the records of 57 women who underwent this procedure. The uteri ranged from 8 to 26 weeks' gestational size. The weight of the leiomyomas ranged from 28 g to 998 g (mean, 247 g); operative time ranged from 40 to 285 minutes (mean 127 minutes) and blood loss from 50 mL to 1,600 mL (mean, 267 mL). All procedures were completed without full laparotomy. Complications included one case of Klebsiella pneumonia requiring several days of antibiotics, and an incisional hernia at the minilaparotomy site. Forty-one patients were discharged on or before the first postoperative day, 12 on day 2, and four after 72 hours. Most women resumed normal activity within 3 weeks.
We found laparoscopically assisted myomectomy to be a safe alternative to myomectomy by laparotomy. It is technically less difficult than laparoscopic myomectomy, allows better closure of the uterine defect, and may require less time to perform.
本研究旨在评估腹腔镜联合小切口剖腹术切除单个及多个大子宫肌瘤的疗效。
腹腔镜用于治疗相关盆腔病变，识别子宫肌瘤并将其牵引至小切口剖腹术切口处，手术结束时通过该切口冲洗清除血凝块和碎屑。通过此切口，抓取、剥除、切碎子宫肌瘤，并分层修复子宫缺损。
我们回顾性评估了57例行该手术的女性患者的记录。子宫大小相当于妊娠8至26周。子宫肌瘤重量为28克至998克（平均247克）；手术时间为40至285分钟（平均127分钟），失血量为50毫升至1600毫升（平均267毫升）。所有手术均未进行完全剖腹术。并发症包括1例需使用抗生素治疗数天的克雷伯菌肺炎，以及小切口剖腹术部位的切口疝。41例患者在术后第1天或之前出院，12例在第2天出院，4例在72小时后出院。大多数女性在3周内恢复正常活动。
我们发现腹腔镜辅助子宫肌瘤切除术是剖腹子宫肌瘤切除术的一种安全替代方法。它在技术上比腹腔镜子宫肌瘤切除术难度小，能更好地闭合子宫缺损，且可能所需手术时间更短。
