Darai E, Deval B, Darles C, Benifla J L, Guglielmina J N, Madelenat P
Hôpital Bichat, Paris.
Contracept Fertil Sex. 1996 Oct;24(10):751-6.
The purpose of this study of 109 myomectomies is to evaluate the feasibility, limits and results in term of fertility of the laparoscopic myomectomy.
Retrospective study from January 1990 to December 1993, including 109 patients having had a myomectomy, 39 by laparotomy (35,7%) and 70 by laparoscopy.
The average number of myomas extracted by laparoscopy and by laparotomy were 1.5 and 6.7 respectively. The diameter of the major myoma was 7 cm in the laparotomic group versus 6.2 cm in the laparoscopic group. Among 70 myomectomies approached by laparoscopy, 29 (41,4%) have necessitated a laparoconversion. The reason of this conversion was mainly the size of the myoma (superior 5 cm) in 21 cases, the number of myomas (superior 5) in 6 cases, the interstitiel location of the myoma in 1 case and a per-operative hemorrhage in 1 case. Among 109 patients having had a myomectomy, 60 (55%) desired a pregnancy including 22 patients having laparoscopy myomectomy. Among these 22 patients, 8 have been pregnant (36.4%) allowing 9 pregnancies (4 deliveries, 4 missed abortions and 1 intrauterin fetal death).
Our results confirm that the laparoscopic myomectomy would have to be reserved to patients presenting to the most 4 myomas with a diameter < or = 7 cm. Results in term of fertility of the laparoscopic myomectomy are similar to these of patients having a laparoconversion.
本项针对109例肌瘤切除术的研究旨在评估腹腔镜肌瘤切除术在生育方面的可行性、局限性及效果。
对1990年1月至1993年12月进行回顾性研究，包括109例行肌瘤切除术的患者，其中39例经剖腹手术（35.7%），70例经腹腔镜手术。
腹腔镜手术和剖腹手术切除肌瘤的平均数量分别为1.5个和6.7个。剖腹手术组主要肌瘤的直径为7厘米，而腹腔镜组为6.2厘米。在70例经腹腔镜手术的肌瘤切除术中，29例（41.4%）需要转为剖腹手术。转为剖腹手术的主要原因是：肌瘤大小（大于5厘米）21例，肌瘤数量（大于5个）6例，肌瘤位于肌层内1例，术中出血1例。在109例行肌瘤切除术的患者中，60例（55%）希望怀孕，其中22例行腹腔镜肌瘤切除术。在这22例患者中，8例已怀孕（36.4%），共9次妊娠（4次分娩、4次稽留流产和1次宫内胎儿死亡）。
我们的结果证实，腹腔镜肌瘤切除术应仅适用于肌瘤最多4个、直径≤7厘米的患者。腹腔镜肌瘤切除术在生育方面的效果与转为剖腹手术的患者相似。
