催产素在子宫肌瘤切除术中的作用:一项随机研究

To evaluate the influence of oxytocin on peroperative blood loss during myomectomy. From October 1998 to May 2002, 94 patients requiring surgical myomectomy by laparotomy or by the vaginal approach were enrolled in a randomized double blind study. Patients were randomized to two groups. In the first group (47 patients) oxytocin was administered during myomectomy and in the second group (47 patients) a placebo was used. The main outcome measures were peroperative blood loss and rates of blood transfusion and autotransfusion. Peroperative blood loss was no different between the oxytocin group and the placebo group (508 ± 558 ml versus 451 ± 336 ml; P= 0.55). Rates of autotransfusion and blood transfusion were also similar in both groups. Administration of oxytocin during myomectomy did not reduce peroperative blood loss in our study. The benefits of using oxytocin to prevent hemorrhage during myomectomy seem to be limited.

骶棘韧带固定术的并发症

Objective. - To evaluate complications of sacrospinous ligament fixation. Design. - Monocentric retrospective study. Setting. - Department of Obstetrics & Gynecology, La Conception University Hospital, Marcella. Patients and methods. - Between January 1991 and September 2002, 277 women (mean age 64.9 years, range 37 to 92 years) underwent a sacrospinous ligament fixation; 91% had a menopausal status, and 15.5% used hormone replacement therapy. 33.2% of the patients had prior hysterectomy, 28.9% had a history of surgery for prolapse, and 18.8% had associated symptoms of stress urinary incontinence. In all cases, sacrospinous ligament fixation was performed under visual control using conventional stitch. Sacrospin ous ligament fixation was combined with the following procedures: anterior vaginal repair (N =137), additional incontinence surgery (N =31), vaginal hysterectomy (N =137), levator myorraphy (N =203). Main outcome measures. - Intraoperative complications, postoperative complications, long term painful symptoms. Results. - Intraoperative complications were represented by 1 case of vascular wound and four rectal injuries. Main postoperative complications were vaginal haematomas (N =6) and abscesses (N =2). Long term symptoms were perineal pain, sciatic neuralgia, and dyspareunia. Discussion and conclusion. - There was no surgical mortality, and we noted low rates of major complications. Sacrospinous ligament fixation assumes high priority in our therapeutic regimen.

阴式子宫切除术加预防性双侧卵巢切除术中腹腔镜辅助的价值

Objective: This study was undertaken to compare morbidity for women undergoing laparoscopy- assisted vaginal hysterectomy with bilateral oophorectomy (LAVHO) and vaginal hysterectomy with bilateral oophorectomy without laparoscopic assistance (VHO). Study design: Between April 1, 2002, and February 1, 2004, a prospective randomized study at Marseille University Hospital (La Conception) included 48 patients who underwent a hysterectomy with prophylactic bilateral oophorectomy for benign uterine conditions. These patients were allocated to 2 groups (LAVHO vs VHO). The study variables were duration of surgery and of hospitalization and surgical and postoperative complications. Results: There was no significant difference in the duration of surgery between the LAVHO and VHO groups (100.2 ± 27.9 vs 83.9 ± 34.6, P = .08). The rate of complications was significantly higher in the LAVHO group (13/24 [54.1% ] vs 6/24 [25% ], P = .039). Conclusion: The overall complication rate was higher with LAVHO than VHO. It thus appears that laparoscopic assistance is not useful in performing vaginal hysterectomies with prophylactic bilateral oophorectomies in patients without other related disorders (endometriosis, adhesions, adnexal anomalies).

阴道后穹隆切开行经阴道子宫肌瘤剔除术:在普通病例中实施的可能性

Background: Myomectomy is classically performed via laparotomy. Endoscopic surgery is limited for some indications. Vaginal myomectomy is a surgical procedure that has recently been evaluated. The aim of this study was to evaluate the feasibility, reproducibility and complication rate of vaginal myomectomy via posterior colpotomy. Methods: A retrospective study was performed from November 1998 to February 2001 in three departments of gynaecology. Results: Fortyfive patients were involved, 17 (37.8%) of whom underwent laparoscopy before vaginal myomectomy for evaluation or treatment of a second pelvic disorder. Myomectomy was performed vaginally in 40 (89%) of the 45 patients. Peroperative laparotomy was required in five patients (11%), either because vaginal myomectomy proved impossible (four cases) or because of rectal injury (one case). One patient needed supplementary laparotomy on day 8 for the treatment of a pelvic abscess. Conclusion: Posterior vaginal myomectomy seems to be a feasible and reproducible surgical procedure. The success rate of vaginal myomectomy in this study was over 80%. Further randomised studies are needed to compare this procedure with laparotomy and laparoscopy.

临床与超声因素对米索前列醇在妊娠早期流产中效力的影响

An observational study including 276 patients with early pregnancy failure was performed to evaluate the clinical and ultrasound factors influencing the efficacy of misoprostol in the treatment of first trimester pregnancy failure. Gestational age did not influence the efficacy of this treatment and the success rate was inversely proportional to parity.