Application of in situ morcellation of uterus myoma in laparoscopic myomectomy

doi:10.3877/cma.j.issn.1673-5250.2019.05.014

Objective

To explore the value of uterus myoma (UM) treatment by in situ morcellation of UM in laparoscopic myomectomy (LM).

Methods

A total of 72 patients who were diagnosed as UM and received LM treatment in Chengdu Women′s and Children′s Central Hospital between June 2014 and June 2018 were randomly selected as research subjects by random envelope method. By random number table method, the patients were randomly divided into study group (n=36, treatment UM by in situ morcellation of UM in LM) and control group (n=36, stripping UM first and then morcellation of UM in LM). The operation duration time, volume of intraoperative blood loss, postoperative vent time, and length of hospital stays were compared between two groups by independent-samples t test. The procedures followed in this study were in accordance with the standards established by the Ethics Committee of the Chengdu Women′s and Children′s Central Hospital, and this study was approved by this committee (approval date: April 14 of 2014). Clinical research informed consent was obtained and signed from each patient.

Results

①There were no statistically significant differences between two groups in the general clinical data, such as maximum diameter of UM, and the age, body mass index (BMI), and proportions of history of abdominal surgery, multipara, number of UM ≥2 of patients (P>0.05). ②The operation duration time in study group was (42.4±5.5) min, which was statistically shorter than that of (78.6±6.0) min in control group, and volume of intraoperative blood loss in study group was (20.5±4.2) mL, which was significantly lower than that of (48.2±5.1) mL in control group, and both the differences were statistically significant (t=3.762, 3.523; P=0.001, 0.012). There were no significant differences between two groups in the postoperative vent time and length of hospital stays (P>0.05). There were no surgically related complications in both groups.

Conclusions

Applying in situ morcellation of UM in LM in treatment of UM patients is an efficient way to further reduce operative duration time and the volume of intraoperative blood loss. Because the sample size of this study is relatively small, whether this method is worthy of clinical promotion and application still needs to beconfirmed by multi-center, large-sample size, and randomized controlled trials.

Key words: Leiomyoma, Laparoscopy myomectomy, In situ morcellation of uterus myoma, Postoperative hemorrhage, Length of stay, Female

表1 2组UM患者一般临床资料比较

组别	例数	年龄(岁，±s)	BMI(kg/m²，±s)	UM最大直径(cm，±s)	腹部手术史[例数(%)]	经产妇[例数(%)]	UM数量≥2个[例数(%)]
研究组	36	35.5±7.5	24.2±2.4	7.5±2.5	11(30.6)	22(61.1)	17(47.2)
对照组	36	34.5±9.5	23.8±2.3	7.0±2.0	13(36.1)	23(63.9)	15(41.7)
检验值	?	t＝1.695	t＝1.352	t＝0.926	χ²＝0.250	χ²＝0.059	χ²＝0.225
P值	?	0.086	0.105	0.315	0.617	0.808	0.635

表1 2组UM患者一般临床资料比较

组别	例数	年龄(岁，±s)	BMI(kg/m²，±s)	UM最大直径(cm，±s)	腹部手术史[例数(%)]	经产妇[例数(%)]	UM数量≥2个[例数(%)]
研究组	36	35.5±7.5	24.2±2.4	7.5±2.5	11(30.6)	22(61.1)	17(47.2)
对照组	36	34.5±9.5	23.8±2.3	7.0±2.0	13(36.1)	23(63.9)	15(41.7)
检验值	?	t＝1.695	t＝1.352	t＝0.926	χ²＝0.250	χ²＝0.059	χ²＝0.225
P值	?	0.086	0.105	0.315	0.617	0.808	0.635

表2 2组UM患者术中及术后情况比较(±s)

组别	例数	手术时间(min)	术中出血量(mL)	术后肛门排气时间(h)	住院时间(d)
研究组	36	42.4±5.5	20.5±4.2	13.2±3.1	3.2±0.8
对照组	36	78.6±6.0	48.2±5.1	14.1±3.4	3.5±0.5
t值	?	3.762	3.523	0.665	1.854
P值	?	0.001	0.012	0.252	0.141

表2 2组UM患者术中及术后情况比较(±s)

组别	例数	手术时间(min)	术中出血量(mL)	术后肛门排气时间(h)	住院时间(d)
研究组	36	42.4±5.5	20.5±4.2	13.2±3.1	3.2±0.8
对照组	36	78.6±6.0	48.2±5.1	14.1±3.4	3.5±0.5
t值	?	3.762	3.523	0.665	1.854
P值	?	0.001	0.012	0.252	0.141

[1]	Glaser LM, Friedman J, Tsai S, et al. Laparoscopic myomectomy and morcellation: a review of techniques, outcomes, and practice guidelines[J]. Best Pract Res Clin Obstet Gynaecol, 2018, 46: 99-112.
[2]	Stanhiser J, Mouille B, Flyckt R, et al. Trends over time and surgical outcomes of abdominal, mini-laparotomy, and traditional and robotic-assisted laparoscopy with and without tandem mini-laparotomy: a comparison of myomectomy techniques[J]. J Minim Invasive Gynecol, 2015, 22(6S): S1.
[3]	谢幸，苟文丽. 妇产科学[M]. 8版. 北京：人民卫生出版社，2013: 488.
[4]	干晓琴，刘江，林海，等. 棒球缝合法在腹腔镜下巨大子宫肌瘤剥除术中的应用[J]. 实用医院临床杂志，2016, 13(3): 37-39.
[5]	Marret H, Chevillot M, Giraudeau B, et al. Factors influencing laparoconversions during the learning curve of laparoscopic myomectomy[J]. Acta Obstet Gynecol Scand, 2006, 85(3): 324-329.
[6]	Sinha R, Hegde A, Warty N, et al. Laparoscopic myomectomy: enucleation of the myoma by morcellation while it is attached to the uterus[J]. J Minim Invasive Gynecol, 2005, 12(3): 284-289.
[7]	Sinha R, Hegde A, Mahajan C, et al. Laparoscopic myomectomy: do size, number, and location of the myomas form limiting factors for laparoscopic myomectomy？[J]. J Minim Invasive Gynecol, 2008, 15(3): 292-300.
[8]	Torng PL, Hwang JS, Huang SC, et al. Effect of simultaneous morcellation in situ on operative time during laparoscopic myomectomy[J]. Hum Reprod, 2008, 23(10): 2220-2226.
[9]	杨玲，魏玮，巴哈尔. 腹腔镜下直接旋切法行子宫肌瘤剔除术的临床疗效观察[J]. 新疆医学，2015, 45(6): 757-759.
[10]	徐晓黎，徐云. 改良腹腔镜下子宫肌瘤剔除术的临床效果评价[J]. 临春区学工程，2016, 23(11): 1433-1434.
[11]	于达，杨永华，林艳. 腹腔镜下子宫肌瘤原位粉碎并核除术的临床分析[J]. 中国当代医药，2013, 20(14): 23-26.
[12]	谢祖婵，刘梅，唐惠英，等. 腹腔镜直接旋切法剔除子宫肌瘤的临床疗效[J]. 华夏医学，2015, 28(1): 36-38.
[13]	Chang WC, Chou LY, Chang DY, et al. Simultaneous laparoscopic uterine artery ligation and laparoscopic myomectomy for symptomatic uterine myomas with and without in situ morcellation[J]. Hum Reprod, 2011, 26(7): 1735-1740.
[14]	Alborzi S, Ghannadan E, Alborzi S, et al. A comparison of combined laparoscopic uterine artery ligation and myomectomy versus laparoscopic myomectomy in treatment of symptomatic myoma[J]. Fertil Steril, 2009, 92(2): 742-747.
[15]	Chang WC, Huang PS, Wang PH, et al. Comparison of laparoscopic myomectomy using in situ morcellation with and without uterine artery ligation for treatment of symptomatic myomas[J]. J Minim Invasive Gynecol, 2012, 19(6): 715-721.
[16]	干晓琴，林海，刘江，等. V-Loc倒刺线在腹腔镜下子宫腺肌瘤剥除术中的应用效果观察[J]. 中国计划生育和妇产科，2016, 8(7): 54-56, 62.
[17]	U. S. Food and Drug Administration. Laparoscopic uterine power morcellation in hysterectomy and myomectomy[EB/OL]. (2014-04-17) [2019-08-20]. URL
[18]	U. S. Food and Drug Administration. Laparoscopic uterine power morcellation in hysterectomy and myomectomy[EB/OL]. (2014-11-24) [2019-08-20]. URL
[19]	朱兰，范融. 子宫肌瘤粉碎器应用的热点问题[J]. 中国计划生育和妇产科，2015, 7(11): 1-3, 17.
[20]	Paul PG, Thomas M, Das T, et al. Contained morcellation for laparoscopic myomectomy within a specially designed bag[J]. J Minim Invasive Gynecol, 2016, 23(2): 257-260.
[21]	王金娟，成九梅，金婧，等. 宫颈肌瘤经阴道剔除术与经腹腔镜剔除术的疗效观察[J/CD]. 中华妇幼临床医学杂志(电子版), 2014, 10(6): 779-782.
[22]	李艺平，颜友良，王秀中，等. 开腹与腹腔镜下子宫肌瘤剔除术的对比研究[J/CD]. 中华妇幼临床医学杂志(电子版), 2017, 13(1): 61-64.

[1]	Shuqin Zhang, Lian Chen. Diagnosis and treatment of postpartum intrauterine retained products of conception[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 493-497.
[2]	Jiechun Shi, Ziyu Fan, Yan Xing. Early warning efficiency of different screening methods on cervical adenocarcinoma in situ[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 575-581.
[3]	Dan Tang, Xiaoxi Yao, Bowen Yang, Shaolong Xue, Mengyao Li, Liuxing Wei, Mingrong Xi. The impact of doublecortin-like kinase 1 on the clinical characteristics of endometrioid adenocarcinoma patients[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 582-590.
[4]	Yi Wei, Yuxi Zhou, Ye Yang, Xiufeng Ling, Chun Zhao. Current research status on roles of microRNA on endometrial receptivity[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(03): 266-270.
[5]	Lin Lin, Simeng Tian, Yonghua Yu, Feifei Xu, Mingli Huang. Current research status on treatment of intrauterine adhesion by stem cells and their exosomes[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(03): 271-275.
[6]	Xin Li, Yi Wei, Juan Zhang, Juanjuan Zhang, Xiufeng Ling, Chun Zhao, Mianqiu Zhang. Influencing factors on clinical pregnancy outcomes of frozen-thaw embryo transfer cycle in women of advanced age[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(03): 276-283.
[7]	Xiaoli Shao, Yan Lin, Lingling Zhang, Yaqin Han. Clinical efficacy of uterus myoma injection of lauromacrogol sclerotherapy by ultrasound-guided combined with postoperative mifepristone[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(03): 353-360.
[8]	Weicong Gao, Li Li, Zhonghua Zhang, Xianghui Zhu, Suqiao Liu. Impact of impaired glucose regulation on recurrence within 2 years after modified radical surgery in patients with cervical cancer[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(02): 231-237.
[9]	Yuping Li, Hui Ma, Hang Yu. Clinical efficacy of laparoscopic uterine artery ligation combined with myomectomy for the treatment of uterine fibroids[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(02): 238-244.
[10]	Lin Yang, Rutie Yin. Current research status on etiology and treatment of patients with white lesions of vulva[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(02): 157-165.
[11]	Li Wang, Yueying Wang, Fen Zhou, Yukun Guo, Lina Wei. Current research status in effect of gonadotropin-releasing hormone antagonist on endometrial receptivity[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(06): 629-635.
[12]	Zhengyang Zhou, Kai Chen, Duoliang Qiu, Lening Shao, Haorong Wu, Fengyun Zhong. Analysis and management of postoperative hemorrhage following laparoscopic inguinal hernia repair[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(06): 660-664.
[13]	Li Wei, Hao Zhang, Xin Tan, Shan Deng, Xiufeng Huang, Limin Feng. Interpretation of the association standard for the management of hysteroscopic myomectomy[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2024, 17(04): 199-204.
[14]	Shulin Zhou, Yi Jiang, Jiangnan Qiu, Shan Wu, Chengyan Luo, Lin Yuan, Wenjun Cheng. Anatomy and surgical skills of transumbilical single-port laparoscopic hysterectomy and salpingectomy[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2024, 17(01): 58-61.
[15]	Shen Wang, Ruhai Wang, Chun Li, Zhen Yang, Feilin Sun. Risk factors analysis and prediction model construction of prolonged length of stay in patients with moderate and severe traumatic brain injury[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2024, 14(03): 146-153.

Viewed

Full text

Abstract

Please choose a citation manager

Content to export