Olive DL, Rutherford T, Zreik T, Palter S
Department of Obstetrics and Gynecology, Yale University School of Medicine, Section of Reproductive Endocrinology, 333 Cedar Street, P.O. Box 208063, New Haven, CT 06520-8063.
J Am Assoc Gynecol Laparosc. 1996 Aug;3(4, Supplement):S36. doi: 10.1016/s1074-3804(96)80258-1.
Conservative surgical options for uterine fibroids are abdominal myomectomy, laparoscopic myomectomy, and, more recently, myolysis. Another option for the conservative surgical treatment of fibroids is freezing the structures. This procedure, cryomyolysis, can be performed rapidly by laparoscopic or hysteroscopic access. We performed a pilot study of 14 women with uterine fibroids. All were pretreated with a gonadotropin-releasing hormone (GnRH) agonist for 3 months to reduce uterine and myoma size. Cryomyolysis was performed in each, and the GnRH agonist was discontinued. Magnetic resonance imaging scans were performed in 10 of the 14 women after GnRH agonist treatment before surgery and 4 months postoperatively. Total uterine volume ranged from 41.3 to 1134.8 ml preoperatively and 49.5 to 1320 ml postoperatively, for a mean increase of 22%. Normal uterine volume ranged from 35.6 to 548.7 ml preoperatively and 45.1 to 729.6 ml postoperatively, for a mean increase of 40%. Myoma volume showed a mean decrease of 6% (range 87-28%). Analysis of frozen fibroids revealed a mean volume decrease of 10%. We conclude that cryomyolysis is able to maintain (or slightly reduce) the uterine fibroid at its post-GnRH agonist size, whereas all other uterine tissues return to pretreatment size.
子宫肌瘤的保守手术选择包括开腹肌瘤切除术、腹腔镜肌瘤切除术，以及最近出现的肌瘤溶解术。肌瘤保守手术治疗的另一种选择是冷冻肌瘤组织。这种手术，即冷冻消融术，可以通过腹腔镜或宫腔镜快速进行。我们对14例子宫肌瘤患者进行了一项初步研究。所有患者均先用促性腺激素释放激素（GnRH）激动剂预处理3个月，以减小子宫和肌瘤的大小。对每位患者进行了冷冻消融术，然后停用GnRH激动剂。14例患者中有10例在GnRH激动剂治疗后手术前和术后4个月进行了磁共振成像扫描。术前子宫总体积为41.3至1134.8毫升，术后为49.5至1320毫升，平均增加22%。术前正常子宫体积为35.6至548.7毫升，术后为45.1至729.6毫升，平均增加40%。肌瘤体积平均减少6%（范围为87%至28%）。对冷冻后的肌瘤分析显示平均体积减少10%。我们得出结论，冷冻消融术能够使子宫肌瘤维持在GnRH激动剂治疗后的大小（或略有缩小），而所有其他子宫组织则恢复到治疗前的大小。
