Comparison of Laparoscopic Myomectomy Using in Situ Morcellation With and Without Uterine Artery Ligation for Treatment of Symptomatic Myomas

作者：Chang Wen Chun; Huang Pei Shen; Wang Peng Hui; Chang Daw Yuan; Huang Su Cheng; Chen Szu Yu; Chou Li Yun; Sheu Bor Ching^*

来源：Journal of Minimally Invasive Gynecology, 2012, 19(6): 715-721.

DOI：10.1016/j.jmig.2012.07.008

• In situ morcellation
• Laparoscopic uterine artery ligation
• Myomectomy
• Symptomatic myomas

Study Objective: To evaluate the efficacy of laparoscopic uterine artery ligation (LUAL) before in situ morcellation (ISM) compared with ISM alone. %26lt;br%26gt;Design: Prospective study (Canadian Task Force classification II-1). %26lt;br%26gt;Setting: University-affiliated hospital. %26lt;br%26gt;Patients: One hundred forty-four women with symptomatic uterine myomas, of whom 45 underwent LUAL and ISM and 99 underwent ISM only, from August 2007 through August 2009. %26lt;br%26gt;Interventions: Ligation or no ligation of the uterine arteries before ISM. %26lt;br%26gt;Measurements and Main Results: In the LUAL+ISM group compared with the ISM group, mean (SD) operative time was significantly longer (107 [34] minutes vs 93 [35] minutes; p = .03), and there was less intraoperative blood loss (84 [53] mL vs 137 [166] mL; p %26lt; .001). Eight patients in the ISM group (8.1%) required a blood transfusion, including 4(4.0%) with excessive intraoperative bleeding and 4 (4.0%) with postoperative hematomas. Although myomas in the LUAL+ISM group weighed more (p %26lt; .001), none of the patients in that group had excessive intraoperative bleeding, postoperative hematomas, or required blood transfusion (p = .046). At 2 years of follow-up, in the LUAL+ISM group compared with the ISM group, the myoma recurrence rate was 7% vs 24%, and symptom improvement was reported by 98% of patients vs 86% (statistically significant). %26lt;br%26gt;Conclusion: Laparoscopic myomectomy using an ISM technique with or without simultaneous LUAL may be used in the management of symptomatic uterine myomas; however, LUAL+ISM may result in a better surgical outcome.

• 出版日期2012-12