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 ...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.展开更多
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 ...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.展开更多
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 peri...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.展开更多
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 surroun...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.展开更多
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 ...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.展开更多
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...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.展开更多
目的:比较开腹与腹腔镜下子宫肌瘤剔除术对患者远期术后生活质量的影响,探讨最佳手术途径。方法:选取2017年1—12月于浙江大学医学院附属妇产科医院住院治疗的160例子宫肌瘤患者作为研究对象,根据治疗方式将患者分为开腹子宫肌瘤剔除术...目的:比较开腹与腹腔镜下子宫肌瘤剔除术对患者远期术后生活质量的影响,探讨最佳手术途径。方法:选取2017年1—12月于浙江大学医学院附属妇产科医院住院治疗的160例子宫肌瘤患者作为研究对象,根据治疗方式将患者分为开腹子宫肌瘤剔除术组(开腹组,n=80)和腹腔下镜子宫肌瘤剔除术组(腹腔镜组,n=80)。术后第5年进行随访,收集并记录其病史信息及随访资料,比较两组临床症状[子宫肌瘤症状严重程度问卷(uterine fibroid symptom severity scale,UFS-8)]、生命质量[欧洲五维生命质量调查问卷(European quality of life five dimension five level scale questionnaire,EQ-5D-5L)]、性生活满意度[女性性功能问卷(female sexual function index,FSFI)中的第16个问题]、术后肌瘤残留或复发情况。结果:腹腔镜组下腹部不适、乏力感评分及总分低于开腹组,差异有统计学意义(P<0.05);两组月经量增多、经血成块、经期延长、周期不规律、日间尿频、夜间尿频评分比较,差异无统计学意义(P>0.05)。腹腔镜组自我照顾、日常活动、疼痛或不舒服优于开腹组,EQ-5D-5L总分高于开腹组,差异有统计学意义(P<0.05);但两组行动能力、焦虑或沮丧比较,差异无统计学意义(P>0.05)。腹腔镜组术后性生活满意度高于开腹组,差异有统计学意义(P<0.05);但两组术后肌瘤残留或复发情况比较,差异无统计学意义(P>0.05)。结论:相比传统开腹手术,腹腔镜下子宫肌瘤剔除术术后临床症状改善更佳、生活质量提高更多,性满意度更高,但需告知若选择子宫肌瘤剔除术,术后残留及复发风险较高,术后需严密随访。展开更多
目的:探讨腹腔镜下暂时阻断子宫动脉根治性挖除子宫腺肌病手术学习曲线。方法:回顾分析常州市妇幼保健院2015年12月—2023年8月收治的151例进行腹腔镜下暂时阻断子宫动脉根治性挖除子宫腺肌病手术患者的临床资料。采用累计求和分析(cumu...目的:探讨腹腔镜下暂时阻断子宫动脉根治性挖除子宫腺肌病手术学习曲线。方法:回顾分析常州市妇幼保健院2015年12月—2023年8月收治的151例进行腹腔镜下暂时阻断子宫动脉根治性挖除子宫腺肌病手术患者的临床资料。采用累计求和分析(cumulative sum analysis,CUSUM)法绘制学习曲线,根据所得曲线的临界点将整个过程分为提高期(47例)和熟练期(104例),分析比较2组患者的临床资料和手术结果。结果:根据患者手术时间和手术例数形成手术时间序列图,拟合曲线为y=-27.17ln(x)+330.74(x=手术例数)。根据手术时间绘制的CUSUM曲线的最佳拟合曲线方程为y=-0.005x^(3)-1.387x^(2)+98.643x-253.571(x为手术例数,最优拟合系数R2=0.931,P<0.05),48例即为该手术达到熟练期所需累积的例数。提高期患者手术时间[(263.72±38.07)min vs.(201.65±48.03)min,P<0.001]、术后持续发热率(40.43%vs.22.12%,P=0.020)和术后体温[38.0(37.8,38.1)℃vs.37.7(37.5,38.0)℃,P=0.002]均高于熟练期患者。两阶段患者的术后血红蛋白水平和手术前后血红蛋白差值比较,差异均无统计学意义(P>0.05)。结论:子宫动脉临时阻断能够有效控制术中出血量,术者约需完成48例腹腔镜下暂时阻断子宫动脉根治性挖除子宫腺肌病手术达到技术熟练,但仍需不断熟练手术操作,降低患者感染风险。展开更多
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
文摘目的:比较开腹与腹腔镜下子宫肌瘤剔除术对患者远期术后生活质量的影响,探讨最佳手术途径。方法:选取2017年1—12月于浙江大学医学院附属妇产科医院住院治疗的160例子宫肌瘤患者作为研究对象,根据治疗方式将患者分为开腹子宫肌瘤剔除术组(开腹组,n=80)和腹腔下镜子宫肌瘤剔除术组(腹腔镜组,n=80)。术后第5年进行随访,收集并记录其病史信息及随访资料,比较两组临床症状[子宫肌瘤症状严重程度问卷(uterine fibroid symptom severity scale,UFS-8)]、生命质量[欧洲五维生命质量调查问卷(European quality of life five dimension five level scale questionnaire,EQ-5D-5L)]、性生活满意度[女性性功能问卷(female sexual function index,FSFI)中的第16个问题]、术后肌瘤残留或复发情况。结果:腹腔镜组下腹部不适、乏力感评分及总分低于开腹组,差异有统计学意义(P<0.05);两组月经量增多、经血成块、经期延长、周期不规律、日间尿频、夜间尿频评分比较,差异无统计学意义(P>0.05)。腹腔镜组自我照顾、日常活动、疼痛或不舒服优于开腹组,EQ-5D-5L总分高于开腹组,差异有统计学意义(P<0.05);但两组行动能力、焦虑或沮丧比较,差异无统计学意义(P>0.05)。腹腔镜组术后性生活满意度高于开腹组,差异有统计学意义(P<0.05);但两组术后肌瘤残留或复发情况比较,差异无统计学意义(P>0.05)。结论:相比传统开腹手术,腹腔镜下子宫肌瘤剔除术术后临床症状改善更佳、生活质量提高更多,性满意度更高,但需告知若选择子宫肌瘤剔除术,术后残留及复发风险较高,术后需严密随访。
文摘目的:探讨腹腔镜下暂时阻断子宫动脉根治性挖除子宫腺肌病手术学习曲线。方法:回顾分析常州市妇幼保健院2015年12月—2023年8月收治的151例进行腹腔镜下暂时阻断子宫动脉根治性挖除子宫腺肌病手术患者的临床资料。采用累计求和分析(cumulative sum analysis,CUSUM)法绘制学习曲线,根据所得曲线的临界点将整个过程分为提高期(47例)和熟练期(104例),分析比较2组患者的临床资料和手术结果。结果:根据患者手术时间和手术例数形成手术时间序列图,拟合曲线为y=-27.17ln(x)+330.74(x=手术例数)。根据手术时间绘制的CUSUM曲线的最佳拟合曲线方程为y=-0.005x^(3)-1.387x^(2)+98.643x-253.571(x为手术例数,最优拟合系数R2=0.931,P<0.05),48例即为该手术达到熟练期所需累积的例数。提高期患者手术时间[(263.72±38.07)min vs.(201.65±48.03)min,P<0.001]、术后持续发热率(40.43%vs.22.12%,P=0.020)和术后体温[38.0(37.8,38.1)℃vs.37.7(37.5,38.0)℃,P=0.002]均高于熟练期患者。两阶段患者的术后血红蛋白水平和手术前后血红蛋白差值比较,差异均无统计学意义(P>0.05)。结论:子宫动脉临时阻断能够有效控制术中出血量,术者约需完成48例腹腔镜下暂时阻断子宫动脉根治性挖除子宫腺肌病手术达到技术熟练,但仍需不断熟练手术操作,降低患者感染风险。
