Stringer N H, McMillen M A, Jones R L, Nezhat A, Park E
The Department of Obstetrics and Gynecology, Columbia Michael Reese Medical Center, Chicago, Illinois 60616, USA.
Int J Fertil Womens Med. 1997 Sep-Oct;42(5):288-96.
To evaluate the mechanical performance of the Endo Stitch Laparoscopic Suturing Device and the clinical effectiveness of both a running, locked suture technique and a new modified suture technique for closure of uterine defects after laparoscopic removal of myomas.
Fifty consecutive patients with symptomatic uterine leiomyomata. OBSERVATIONAL METHOD: Retrospective chart review.
The endometrial cavity was entered and sutured laparoscopically, in two layers, in 22 patients. In 28 patients, only the myometrium was sutured. A two-layered closure of the endometrium and myometrium was completed in an average time of 10 minutes. Mechanical problems with the Endo Stitch occurred in 11 cases. In all patients with second-look laparoscopies, the fallopian tubes were patent bilaterally without adhesions. No uterine fistulas were present in any patients with second-look laparoscopies. Posterior myomas were removed and sutured without adhesion formation. Grade 3 adhesions, to the uterine surface, were associated with transverse incisions of the uterus and over-treatment with GnRH analogs.
The Endo Stitch Laparoscopic Suturing Device in combination with a running, locked suture technique achieves a rapid, hemostatic, clinically secure closure of the endometrium and myometrium. The Endo Stitch and our modified suture technique were not associated with adhesions or blockage of the fallopian tubes or uterine fistulas following laparoscopic myomectomies. The initial mechanical problems with the Endo Stitch were resolved. In our experience, currently the Endo Stitch is the best instrument for laparoscopic suture closure of uterine defects.
评估Endo Stitch腹腔镜缝合装置的机械性能，以及连续锁边缝合技术和一种新改良缝合技术在腹腔镜下切除肌瘤后关闭子宫缺损的临床效果。
50例有症状的子宫平滑肌瘤患者。
回顾性病历审查。
22例患者在腹腔镜下进入并缝合子宫内膜腔，分两层进行。28例患者仅缝合子宫肌层。子宫内膜和子宫肌层的两层缝合平均耗时10分钟。Endo Stitch出现机械问题11例。在所有接受二次腹腔镜检查的患者中，双侧输卵管通畅，无粘连。二次腹腔镜检查的患者均未出现子宫瘘。后壁肌瘤切除并缝合后未形成粘连。子宫表面3级粘连与子宫横切口及GnRH类似物过度治疗有关。
Endo Stitch腹腔镜缝合装置结合连续锁边缝合技术可实现对子宫内膜和子宫肌层的快速、止血且临床安全的缝合。Endo Stitch和我们改良的缝合技术在腹腔镜肌瘤切除术后未导致粘连、输卵管堵塞或子宫瘘。Endo Stitch最初的机械问题已得到解决。根据我们的经验，目前Endo Stitch是腹腔镜缝合关闭子宫缺损的最佳器械。
