The Effect of Uterine Artery Occlusion with Tourniquet on Ovarian Reserve during Open Myomectomy at a University Teaching Hospital in Southern Nigeria

Background: The most common surgical treatment for symptomatic uterine fibroids, particularly in women with fertility concerns, is open myomectomy. Given the high vascularity of the uterus, haemorrhage during the procedure is a serious risk that is often mitigated with a uterine tourniquet. Aim and Objectives: To evaluate the effect of uterine artery occlusion with a tourniquet during open myomectomy on ovarian reserve using serial anti-Mullerian hormone (AMH) measurements. Materials and Methods: This was a prospective longitudinal study with a quasi-experimental design and a convenient sampling technique. The study enrolled 47 women who had abdominal myomectomy between September 1, 2021, and March 31, 2022, at the University of Port Harcourt Teaching Hospital. Blood samples were collected before anaesthesia was administered in theatre, on day two, and three months after open abdominal myomectomy for anti-Mullerian hormone assay. The data was collected using a semi-structured proforma, entered into an Excel spreadsheet, and analyzed using SPSS version 25.0 with a 95% confidence interval. Statistical significance level was set at 0.05. Results: The pre-surgery AMH mean value was 1.67 ± 1.44 ng/ml, while the values after using a uterine tourniquet at myomectomy on the second day and three months later were 1.22 ± 1.24 ng/ml and 1.59 ± 1.43 ng/ml, respectively. There was no statistically significant change in AMH levels, and there was no statistically significant relationship between blood loss and tourniquet time and AMH after open abdominal myomectomy. Conclusion: The use of a uterine tourniquet and blood loss during open myomectomy has no effect on ovarian reserve.

Giant exophytic cystic adenomyosis with a levonorgestrel containing intrauterine device out of the uterine cavity after uterine myomectomy: A case report

BACKGROUND A cystic lesion arising from the myometrium of the uterus, termed as cystic adenomyosis, has chocolate-like, thick viscous contents and contains various amounts of endometrial stroma below the glandular epithelium. It is an extremely rare type of adenomyosis.CASE SUMMARY Herein, we report an unusual case of a giant cystic mass in the pelvic cavity after uterine myomectomy. The patient complained of abnormal uterine bleeding and severe dysmenorrhea. After a levonorgestrel-containing intrauterine device(LNG-IUD) was inserted, her symptoms were greatly alleviated. However, the LNG-IUD was detected in the cystic cavity during the follow-up. For fear of the intrauterine device migrating into and damaging the surrounding viscera,surgical treatment was proposed. Therefore, laparoscopic resection of the lesion and removal of the LNG-IUD were performed and cystic adenomyosis with an LNG-IUD out of the uterine cavity was diagnosed.CONCLUSION We believe that myomectomy breaking through the endometrial cavity may have been a predisposing factor for the development of cystic adenomyosis in this case.

Benefits and Limitations of Laparoscopic Myomectomy

Uterine fibroids (also called leiomyoma or myoma) are the most common benign tumor among women of childbearing age. These are often discovered during bimanual examinations and/or ultrasound examinations. Laparoscopic myomectomy offers several benefits to patients such as less blood loss during operation, quick postoperative recovery and shorter hospital stay in comparison to open myomectomy. It has been widely used over the past decades as possible alternative to the traditional laparotomy. In spite of several benefits laparoscopic myomectomy has certain drawbacks such as prolonged time of anesthesia, time consuming procedure, comparatively expensive and weak strength of the uterine scar. Furthermore laparoscopic myomectomy is technically challenging procedure so it requires high degree of training and skill to perform it. Due to its several advantages, it should be taken into consideration for the removal of uterine fibroids.

Faster Healing Process by Sparing Intramural Myoma’s Pseudocapsule during Laparoscopic Myomectomy Compared with Removing It during Open Myomectomy

Uterine fibroids are the most common benign tumours in the reproductive system. They are proliferations of smooth muscle cells of the myometrium containing a large quantity of extracellular matrix and they are surrounded by a pseudo capsule of compressed areolar tissue and smooth muscle cells. They can cause various symptoms such as menorrhage, pain and infertility and therefore they can be a traumatic experience for several women. The treatment of choice is myomectomy. In the past, myomectomy was performed by relatively atraumatic techniques, which involved stretching the myoma from its pseudocapsule to extract the fibroid directly from the surrounding fibromuscular tissue, breaking up the fibrous bridge. Modern laparoscopic intracapsular myomectomy (LIM), however, leaves the fibrovascular network surrounding the myoma (namely the “fibroid neurovascular bundle”) intact which reduces the bleeding and/or uterine musculature trauma, and spares the neuropeptide fibers of the pseudocapsule. In this observational study, we compare the two techniques-laparoscopic intracapsular myomectomy (LIM) and conventional abdominal myomectomy (CAM) regarding the longterm uterine healing and a significantly faster healing process of the uterine incision was achieved by LIM compared to CAM.

Laparoscopic versus Abdominal Myomectomy: Surgical and Post-Operative Outcomes in CHRACERH-Yaounde

Introduction: Fibroid benign tumour of the uterus can be operated either by laparotomy or laparoscopy. Laparoscopy is not well vulgarised in our settings. Objective: The main objective was to compare the surgical and post-operative outcomes of laparoscopic versus abdominal myomectomy. Methods: We performed a comparative analytical cross sectional study from 1st January 2016 to 31st March 2018 consisted of two groups: group 1 of women who underwent laparoscopic myomectomy (LM) and group 2 of women who underwent abdominal myomectomy (AM). The data collected was entered in Epi Info 7.2 version and exported to IBM SPSS Statistics version 22 for analysis. We used alpha error margin of 5% and confidence interval of 95%. Results: We enrolled 50 cases of myomectomy consisted of 33 (66.0%) files for AM and 17 (34.0%) files for LM. The clinical presentation of fibroid was similar in both groups. The main operation time (H) was (1.27 ± 0.13) for laparoscopy which is much less than (2.05 ± 0.07) for laparotomy group (p = 0.006). In AM group we had 04 post-operatory complications against zero complications in LM group but the difference was not statistically significant (p = 0.387). In the second look laparoscopy, the types of adhesions were not statistically significant (p = 0.471). Conclusion: Laparoscopic offers advantages compared to abdominal myomectomy.

Pseudoaneurysm after abdominal myomectomy: A rare but catastrophic complication

Background: Uterine artery pseudoaneurysm is a rare diagnosis made postoperatively after pelvic surgery. The exact etiology is unknown however it is speculated to occur when an artery is lacerated and the perivascular tissue maintains persistent blood flow with the parent vessel. It can present with severe hemorrhage two to four weeks after an uncomplicated post operative course. Case: A 45 year old presented with vaginal hemorrhage and hypotension two weeks after abdominal myomectomy. Transvaginal ultrasound with doppler diagnosed pseudoaneurysm of the uterine artery. The patient was successfully treated with endovascular embolization utilizing micro coils. Conclusion: Transvaginal ultrasound is a useful technique in diagnosing pseudoaneurysms. Endovascular embolization is a minimally invasive, safe and effective way to treat this rare complication in institutions that have access to interventional radiology procedures.

Parasitic leiomyoma in the trocar site after laparoscopic myomectomy:A case report

BACKGROUND Laparoscopic myomectomy is increasingly used for resecting gynecological tumors.Leiomyomas require morcellation for retrieval from the peritoneal cavity.However,morcellated fragments may implant on the peritoneal cavity during retrieval.These fragments may receive a new blood supply from an adjacent structure and develop into parasitic leiomyomas.Parasitic leiomyomas can occur spontaneously or iatrogenically;however,trocar-site implantation is an iatrogenic complication of laparoscopic uterine surgery.We describe a parasitic leiomyoma in the trocar-site after laparoscopic myomectomy with power morcellation.CASE SUMMARY A 50-year-old woman presented with a palpable abdominal mass without significant medical history.The patient had no related symptoms,such as abdominal pain.Computed tomography findings revealed a well-defined contrast-enhancing mass measuring 2.2 cm,and located on the trocar site of the left abdominal wall.She had undergone laparoscopic removal of uterine fibroids with power morcellation six years ago.The differential diagnosis included endometriosis and neurogenic tumors,such as neurofibroma.The radiologic diagnosis was a desmoid tumor,and surgical excision of the mass on the abdominal wall was successfully performed.The patient recovered from the surgery without complications.Histopathological examination revealed that the specimen resected from the trocar site was a uterine leiomyoma.CONCLUSION Clinicians should consider the risks and benefits of laparoscopic vs laparotomic myomectomy for gynecological tumors.Considerable caution must be exercised for morcellation to avoid excessive tissue fragmentation.

Laparoscopic myomectomy versus open myomectomy in uterine fibroid treatment: A meta-analysis

Objective:Uterine fibroids are the most commonly occurring benign solid tumors in women,and laparoscopic or open myomectomy constitutes the primary option for treatment.However,both methods are under debate currently in terms of efficacy and safety.In this meta-analysis we assessed the efficacy and safety of the two procedures.Methods:We conducted a comprehensive literature search of PubMed,ScienceDirect,and the Cochrane Library in December 2020.The search terms included“open myomectomy”,“myomectomies”,“laparoscopic”,and“uterine fibroids”.We then selected the randomized control trials published from 1996 to 2019 and compared laparoscopic and open myomectomies.Results:We included 10 studies of 449 patients who underwent laparoscopic myomectomy and 449 patients who underwent open myomectomy.The data revealed that laparoscopic myomectomy was associated with reduced blood loss(MD=-34.43;95%CI,-34.92 to-33.94;p<0.001),an attenuated decline in hemoglobin(MD=-1.04;95%CI,-1.14 to -0.93;p<0.001),less post-operative pain at 24 h(MD=-0.51;95%CI,-0.83 to -0.19;p=0.002),and fewer overall complications(OR=0.42;95%CI,0.24 to 0.71;p=0.001)relative to open myomectomy;but the former possessed a longer operative time(MD=12.96;95%CI,9.94 to 15.97;p<0.001).There were no significant differences in pregnancy rate(OR=1.39;95%CI,0.72 to 2.68;p=0.33)or recurrence rate of postoperative uterine fibroids(OR=1.15;95%CI,0.60 to 2.18;p=0.67)between the two groups.Conclusion:Laparoscopic myomectomy displayed superior results compared to open myomectomy,although the former involved a longer operating time.

Enterovesical Fistula Complicating Myomectomy: A Case Report

Background: Enterovesical fistula is an abnormal communication between the bladder and the gastrointestinal tract. It is an uncommon type of genital fistula, occasionally complicating pelvic surgeries. However, it is the most common type of fistula associated with diverticular disease of the colon. Other causes include cancer, trauma and iatrogenic injuries. Pneumaturia and fecaluria usually implies enterovesical fistula. Enterovesical fistula complicating myomectomy is an uncommon finding. Our aim is to report a case of enterovesical fistula following myomectomy. Case presentation: She is a 33-year-old nullipara who presented at the National Obstetric Fistula Centre, Abakaliki, Ebonyi State, South-Eastern Nigeria with a history of fecaluria, pneumaturia and haematochezia which started after myomectomy. Feculent fluid was obtained on urethral catheterization. Cystography was suggestive of enterovesical fistula. Conclusion: Enterovesical fistula is a possible complication of myomectomy. A high index of suspicion for this rare but potentially devastating condition is important for early diagnosis and appropriate management.

LAPAROSCOPIC MYOMECTOMY

Objective. To investigate the indications, surgical techniques and complications of laparoscopic myomectomy. Materials and methods. A retrospective study was carried out in 74 patients with fibroids >3cm from March, 1995 until May,2000 at PUMC Hospital. Indications for surgery were symptomatic fibroids（ 20 cases） , mainly pain or urine frequency； progressively increasing fibroid size (7 cases)； coexistent adnexal pathology（ 26 cases） and infertility（ 21 cases） . Results. The number of fibroids of each patient varied from 1 to 4 with single fibroid of 62 cases (83.7％ ).The fibroids were located in anterior wall (30 cases), posterior wall (23 cases) and fundus (21 cases). A total of 93 fibroids were removed from these patients including 16 intramural fibroids and 77 subserous fibroids. The size of dominant fibroids ranged from 3～ 8 cm (mean 4.8 cm). In 19 cases (25.6％ ),the uterine wall was sutured in one layer. Mean duration of operation was 73 minutes and mean blood loss was 82 ml. Longer operating time and more blood loss were observed in patients with fibroids≥ 4cm than those with fibroids < 4cm. The difference was statistically significant (P< 0.05). Mean postoperative hospital stay was 3.2 days and overall complication rate was 1.4％ . The average postoperative follow- up period was 22 months (1～ 62 months). All the patients with symptoms showed remission of their complaints at 2- month follow- up. Recurrence of fibroid occurred in 1 case 1 year after initial operation and second laparoscopic myomectomy was given to her successfully. Five patients became pregnant. The pregnancy was uneventful and proceeded to selective caesarean section at term pregnancy in 4 cases. One miscarriage occured at 8 weeks in the 5th case. No adhesions at myomectomy site were found in these 5 patients. Conclusions. Our study suggests the feasibility of laparoscopic myomectomy in selected patients, which leads to effectiveness, low complication rate and satisfactory remission of symptoms. Further study on recurrence and fertility must be continued.

A comparative analysis of spontaneous fertility after myomectomy by laparotomy associated or not with a“second look”laparoscopy

Objective:The importance of a“second look”laparoscopy for adhesion formation after myomectomy by laparotomy in improving fertility is not clearly defined in our context.The aim of this study was to compare spontaneous fertility after myomectomy by laparotomy between women who underwent a“second look”laparoscopy and those who did not.Methods:We conducted an analytical cross-sectional study with retrospective data collection from January 1,2008 to December 31,2015,comparing spontaneous fertility between patients who underwent“second-look”laparoscopy after myomectomy by laparotomy to those who did not.Firstly,data was collected from the records of patients included in the study.Secondly,through phone calls,informed consent for each participant was obtained after which inquiries were made regarding their fertility status.Results:After a period of 24 months,23 patients(47.9%)with“second look”laparoscopy conceived,compared to 37 patients(35.2%)without“second look”laparoscopy(p=0.136);and 24 patients(50.0%)with“second look”had term pregnancies compared to 39 patients(37.1%)without“second look”laparoscopy(p=0.134).Conclusion:Spontaneous fertility rates seemed to be improved after a“second look”laparoscopy,however,there was no statistically significant difference between spontaneous fertility rates obtained after myomectomy by laparotomy,irrespective of the fact that the patient had undergone a“second look”laparoscopy or not at Yaounde Gyneco-Obstetric and Pediatric Hospital.

Contribution of the Tourniquet in the Prevention of Haemorrhages during Myomectomies at the University Hospital of Brazzaville

Objective: To check the effectiveness of tourniquet in the prevention of haemorrhage during myomectomies at the University Hospital of Brazzaville. Patients and methods: Analytical cross-sectional study, conducted at the University Hospital of Brazzaville from June 1, 2014 to June 30, 2016. Recruitment was performed by randomly matching each case of myomectomy performed using a tourniquet with two cases of myomectomy without tourniquet (50 cases vs 100 witnesses). We used as a tourniquet, the surgical glove knotted and tightened sufficiently at the level of the isthmus of the uterus to temporarily occlude the uterine arteries to ensure haemostasis lasting no more than one hour. Results: The mean age of the patients was similar in both groups (36, 1 ± 2.2 years vs 36.2 ± 1.9 years, P > 0.05). Menorrhagia was the most common indication of myomectomy in both groups (76% vs. 78% P > 0.05). The mean haemoglobin level of the patients before the myomectomies was 9.03 ± 1.10 g/dl vs 9, 75 ± 1.29 g/dl;P > 0.05. Intraoperative uterine features were similar in size (18 weeks gestation, 14 - 24) and number of myomas (5 vs 4, P > 0.05) in both groups. Polymyomectomy was more common in both groups (76% vs 73%, P > 0.05). Blood loss was reduced in the tourniquet group (90.5 ± 4.6 ml vs 200.4 ± 5.6 ml;P 0.05), as well as the use of blood transfusion (8% vs 50%, P 0.05). Use of the number of sutures was reduced in the group with tourniquet (3 ± 0.2 vs 6 ± 0.2 P 0.05). The duration of the procedure was shorter in the group with tourniquet (51.5 ± 4 min vs 83 ± 7 min, P 0.05). Postoperative mean haemoglobin of patients was no different between the two groups (9.4 ± 0.7 g/dl vs 9.2 ± 0.5, P > 0.05). The overall cost of management was reduced in the group with tourniquet (190,680 ± 1450 F CFA vs 256,800 ± 2350 FCFA;P 0.05). Conclusion: The use of tourniquet during myomectomies significantly reduces blood loss and the use of blood transfusion. We also obtain the notorious reduction in the use of sutures, the duration of interventions, and the overall cost of care. Thus, we encourage the systematic use of tourniquet during myomectomies by laparotomy.

Comparison of the degree of inflammatory stress response of laparoscopic myomectomy and abdominal surgery

Objective: To study the degree of inflammatory stress response of laparoscopic myomectomy and abdominal surgery. Methods: Patients who underwent myomectomy in Maternal and Child Health Hospital of Dayi County between June 2014 and October 2017 were retrospectively analyzed, and according to different operation methods, they were divided into the laparoscopy group and the control group who underwent laparoscopic surgery and open surgery respectively. The contents of inflammatory factors and stress mediators in serum as well as the expression of inflammatory molecules and stress molecules in peripheral blood were measured before surgery and 1 d after surgery. Results: Compared with those of same group before surgery, serum TNF-α, sICAM1, sVCAM1, sTREM1, GH, Cor, C-P, FT4 and CRP levels as well as peripheral blood JAK2, STAT3, Notch2, Hes1, Nrf2, HO-1, MPO and FOXP3 expression intensity of both groups of patients were significantly higher after surgery, and serum TNF-α, sICAM1, sVCAM1, sTREM1, GH, Cor, C-P, FT4 and CRP levels as well as peripheral blood JAK2, STAT3, Notch2, Hes1, Nrf2, HO-1, MPO and FOXP3 expression intensity of laparoscopy group of patients after surgery were lower than those of control group. Conclusion: Compared with abdominal surgery, laparoscopic myomectomy can reduce the degree of postoperative inflammatory stress response.

Comparison of the degree of inflammatory stress response of laparoscopic myomectomy and abdominal surgery

Objective:To study the degree of inflammatory stress response of laparoscopic myomectomy and abdominal surgery.Methods: Patients who underwent myomectomy in Maternal and Child Health Hospital of Dayi County between June 2014 and October 2017 were retrospectively analyzed, and according to different operation methods, they were divided into the laparoscopy group and the control group who underwent laparoscopic surgery and open surgery respectively. The contents of inflammatory factors and stress mediators in serum as well as the expression of inflammatory molecules and stress molecules in peripheral blood were measured before surgery and 1 d after surgery.Results: Compared with those of same group before surgery, serum TNF-α, sICAM1, sVCAM1, sTREM1, GH, Cor, C-P, FT4 and CRP levels as well as peripheral blood JAK2, STAT3, Notch2, Hes1, Nrf2, HO-1, MPO and FOXP3 expression intensity of both groups of patients were significantly higher after surgery, and serum TNF-α, sICAM1, sVCAM1, sTREM1, GH, Cor, C-P, FT4 and CRP levels as well as peripheral blood JAK2, STAT3, Notch2, Hes1, Nrf2, HO-1, MPO and FOXP3 expression intensity of laparoscopy group of patients after surgery were lower than those of control group. Conclusion: Compared with abdominal surgery, laparoscopic myomectomy can reduce the degree of postoperative inflammatory stress response.

Effect of laparoscopic myomectomy on inflammatory reaction, immune function, stress hormones and ovarian function

Objective: To investigate the effect of laparoscopic myomectomy on inflammatory reaction, immune function, stress hormones and ovarian function. Methods: Selected a total of 82 patients with hysteromyoma accorded with the screening criteria as the objects of study, according to the random data table, the patients were divided into the control group (n=41) and the observation group (n=41);The patients in the control group received traditional laparotomy myomectomy, and the observation group patients received laparoscopic myomectomy. The inflammatory reaction, immune function, stress hormone and ovarian function levels were compared between the two groups before and after treatment (before operation and after 1 d of operation). Results: After comparison, before treatment the difference of TNF-α, CRP, CD3+, CD4+, CD8+, CD4+/CD8+, COR, NE, LH, FSH and E2 levels between the groups was not statistically significant;After treatment, the TNF-α, CRP, CD8+, COR, NE, LH and FSH levels of two groups were significantly increased, and the levels after treatment in the control group were significantly higher than the observation group, the difference was statistically significant;The levels of CD3+, CD4+, CD4+/CD8+ and E2 in the observation group were significantly higher than those in the control group, the difference was statistically significant. Conclusion: Laparoscopic myomectomy can effectively reduce the inflammatory reaction and stress reaction, and have a less influence on the immune function and ovarian function, which is more conducive to postoperative rehabilitation.

腹腔镜子宫肌瘤剔除术对子宫肌瘤患者盆底功能、卵巢功能的影响

目的探讨腹腔镜子宫肌瘤剔除术(LM)对子宫肌瘤患者盆底功能、卵巢功能的影响。方法纳入2021年1月至2022年10月濮阳市安阳地区医院收治的80例子宫肌瘤患者,按抽签法分两组。对照组40例行开腹子宫肌瘤剔除术(AM),研究组40例行LM,对比两组手术前后疼痛因子[心肌细胞P物质(SP)、前列腺素E_2(PGE_2)]、应激反应指标[去甲肾上腺素(NE)、皮质醇(COR)]、免疫功能指标(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))、盆底功能指标[盆底障碍影响简易问卷7(PFIQ-7)]及卵巢功能指标[雌二醇(E_2)、促黄体生成素(LH)、促卵泡激素(FSH)]。结果术后1 d、术后3 d时,研究组血清SP、PGE_2、NE、COR水平低于对照组,差异有统计学意义(P<0.05)。术后1d时,两组CD3^(+)、CD4^(+)及CD4^(+)/CD8^(+)功能指标与术前相比均有所降低,但研究组明显高于对照组,差异有统计学意义(P<0.05);而两组的CD8^(+)功能指标与术前相比有所升高,但研究组明显低于对照组,差异有统计学意义(P<0.05)。术后1个月、术后3个月时,两组PFIQ-7评分均有所升高,但研究组明显低于对照组,差异有统计学意义(P<0.05)。术后3个月、术后6个月时,研究组血清E_2水平高于对照组,而血清LH、FSH水平低于对照组,差异有统计学意义(P<0.05)。结论对子宫肌瘤患者行LM可有效减轻机体疼痛程度、应激反应及对免疫、盆底和卵巢功能的负面影响,优势较为显著,具有进一步的使用价值。

腹腔镜下子宫肌瘤剥除术与传统开腹手术对子宫肌瘤患者的疗效对比

目的 对比腹腔镜下子宫肌瘤剥除术与传统开腹手术对子宫肌瘤患者的效果。方法 98例子宫肌瘤患者作为研究对象,随机分为对照组和观察组,每组49例。对照组采用传统开腹手术治疗,观察组采用腹腔镜下子宫肌瘤剥除术治疗。比较两组手术相关指标、术后并发症发生情况及手术前后内分泌功能指标[促卵泡生成素(FSH)、促黄体生成素(LH)]水平。结果 观察组术中出血量(93.6±12.1)ml少于对照组的(116.4±17.5)ml,恢复排气时间(24.3±5.2)h、住院时间(5.3±1.1)d短于对照组的(41.6±8.7)h、(8.2±0.6)d,手术时间(74.3±10.5)min长于对照组的(57.2±6.3)min,差异明显(P<0.05)。术后3个月,观察组FSH、LH水平与本组术前比较无明显差异(P>0.05);术后3个月,对照组FSH、LH水平均比本组术前有所上升,差异明显(P<0.05)。术后3个月,观察组FSH、LH水平分别为(4.39±0.16)、(6.78±0.65)U/L,低于对照组的(7.52±0.53)、(8.75±1.03)U/L,差异明显(P<0.05)。观察组术后并发症发生率为8.16%,显著低于对照组的22.45%,差异明显(P<0.05)。结论 腹腔镜下子宫肌瘤剥除术治疗子宫肌瘤的安全性较高,对患者内分泌功能影响较小,且能减少并发症发生,促进患者病情康复,值得临床推广。

腹腔镜子宫肌瘤剥除术中不同缝合方法对子宫肌瘤患者应激反应和术后并发症的影响

目的探讨腹腔镜子宫肌瘤剥除术(LM)中不同缝合方法对子宫肌瘤(UF)患者应激反应和术后并发症的影响。方法回顾性分析2019年12月至2021年12月吉安市中心人民医院收治的70例UF患者的临床资料,均行LM,根据缝合方式的不同分为传统缝合组(n=34,采用传统缝合法)和棒球缝合组(n=36,采用棒球缝合法)。比较两组围手术期指标、手术后恢复情况、应激反应指标[甲肾上腺素(NE)、皮质醇(Cor)、血管紧张素Ⅱ(AngⅡ)、促肾上腺皮质激素释放激素(CRH)]及手术后并发症的情况。结果棒球缝合组手术时间、切口缝合时间均短于传统缝合组,术中出血量少于传统缝合组,差异有统计学意义(P<0.05);两组术后引流量比较差异无统计学意义。棒球缝合组下地活动时间、住院时间、术后排气时间均短于传统缝合组,差异有统计学意义(P<0.05)。术后,棒球缝合组NE、Cor、AngⅡ及CRH水平均低于传统缝合组,差异有统计学意义(P<0.05)。两组并发症发生率比较差异无统计学意义。结论LM术中采用棒球缝合法能缩短UF患者的手术时间、住院时间、切口缝合时间,减少术中出血,改善术后恢复情况,减少应激反应,值得临床推广应用。

宫腔镜子宫肌瘤电切术与腹腔镜子宫肌瘤剔除术疗效比较

目的 对比分析子宫肌瘤采取宫腔镜下子宫肌瘤电切术(transcervical resection of myoma, TCRM)与腹腔镜下子宫肌瘤剔除术(laparoscopic lyomectomy, LM)的疗效。方法 回顾性选取2020年1月—2023年8月昆山市第二人民医院收治的84例子宫肌瘤患者的临床资料,按手术方案不同分为观察组和对照组,各42例。观察组采用TCRM治疗,对照组采用LM治疗。对比两组手术指标、卵巢储备功能及术后并发症发生情况。结果 观察组的手术时间为(42.41±9.05)min、术中出血量为(74.12±20.06)mL、术后排气时间为(14.56±3.06)h、住院时间为(4.55±0.78)d,均优于对照组的(61.84±12.35)min、(95.61±22.36)mL、(19.80±5.12)h、(6.30±1.28)d,差异有统计学意义(t=8.224、4.636、5.693、7.566,P均<0.05)。两组患者的雌二醇、黄体生成素和卵泡刺激素对比,差异无统计学意义(P均>0.05)。观察组术后并发症总发生率为4.76%(2/42),低于对照组的19.05%(8/42),差异有统计学意义(χ^(2)=4.087,P<0.05)。结论 LM和TCRM治疗子宫肌瘤均能取得良好效果,且对卵巢功能影响较小,但TCRM手术时间更短,术后康复更快,并发症较少。

胃肠三针调神针法联合桂枝茯苓丸对开腹子宫肌瘤剔除术后胃肠功能恢复、应激反应及炎症水平的影响

目的探讨胃肠三针调神针法联合桂枝茯苓丸对开腹子宫肌瘤剔除术后患者胃肠功能恢复、应激反应及炎症水平的影响。方法收集2021年8月—2022年8月在医院择期进行开腹子宫肌瘤剔除术的53例子宫肌瘤患者,根据随机数字分配法分为试验组(27例)和对照组(26例),对照组予以常规针刺治疗,试验组予以胃肠三针调神针法联合桂枝茯苓丸,所有患者均治疗7 d。对比两组临床疗效、胃肠功能、胃肠激素水平、应激反应、血清炎症因子、不良反应及随访复发率。采用SPSS 23.0软件进行统计学分析。结果治疗后与对照组相比,试验组临床总有效率较高(P<0.05)。与对照组相比,试验组肠鸣音恢复时间、肛门排气、首次排便时间缩短(P<0.05)。与治疗前比,治疗后两组胃泌素(gastrin,GAS)、胃动素(motilin,MTL)水平升高,血管活性肠肽(vasoactive intestinal peptide,VIP)水平降低;与对照组比,治疗后试验组MTL、GAS水平较高,VIP水平较低(P<0.05)。与治疗前比,治疗后两组C-反应蛋白(C-reactive protein,CRP)、白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平降低;与对照组比,治疗后试验组CRP、IL-6、TNF-α水平较低(P<0.05)。与治疗前比,治疗后两组胰岛素抵抗指数(insulin resistance index,HOMA-IR)及血管阻力指数(vascular resistance index,RI)水平降低;与对照组比,治疗后试验组RI、HOMA-IR水平较低(P<0.05)。两组不良反应发生情况相比,差异无统计学意义(P>0.05)。与对照组相比,试验组复发率较低(P<0.05)。结论胃肠三针调神针法联合桂枝茯苓丸能有效促进开腹子宫肌瘤剔除术后胃肠功能恢复,调节胃肠激素水平,通过调节机体内炎症指标及应激状态提高治疗效果,远期复发率较低,适宜临床应用推广。