【摘要】 目的 比较腹腔镜和开腹子宫肌瘤切除术在术后第1周的临床效果。 方法 将2008年1月-2009年12月收治的34例子宫肌瘤患者随机分为腹腔镜组17例，开腹组17例。所有患者均为肌壁间肌瘤或浆膜下肌瘤，肌瘤直径在5~15 cm之间且数目≤3个。 结果 两组患者手术时间相近；腹腔镜组术后体温恢复正常时间、肛门排气时间、排尿时间均短于开腹组（Plt;0.05）；腹腔镜组、开腹组术后血红蛋白下降更为明显（Plt;0.05）；术后7 d，开腹组腹痛视觉模拟评分明显高于腹腔镜组（Plt;0.05）。 结论 腹腔镜下子宫肌瘤切除术具有创伤小、恢复快、疼痛轻等优点,是一种安全有效的手术方法。【Abstract】 Objective To compare the outcome of myomectomy performed by laparotomy and laparoscopy in the first 7 days after surgery. Methods Thirty-four patients with myoma less than three and in diameter of 5-15 cm from January 2008 to December 2009 were randomly divided into laparotomy group and laparoscopy group. Results Operation lengths were similar in the two groups. Time of paralytic ileus (Plt;0.05) and discharge (Plt;0.05) were longer in laparotomy group than laparoscopy group. Compared with laparoscopy group, laparotomy group had a greater hemoglobin decline (Plt;0.05). Time of post-operation fever were longer in laparotomy group than laparoscopy group (Plt;0.05). Seven days after surgery, the visual analogue scores of abdominal pain were higher in laparotomy group than in laparoscopy group (Plt;0.05). Conclusion Compared with the laparotomy myomectomy, laparoscopy myomectomy have mini trauma, quicker post operative recovery, and less pain. This method is safe and effective.
Objective To improve the knowledge of pulmonary benign metastasizing leiomyoma.Methods A case of pulmonary benign metastasizing leiomyoma diagnosed in the First Affiliated Hospital of Nanjing Medical University was analyzed.Results A 32-year-old woman suffered from chest stuffiness,heavy pant and weakness after myomectomy in amonth. Chest CT showed miliary shadowwas diffused in both sides of her lungs, but serumtumor marker was normal. When the chest CT result did not change significantly after four-week’s anti-tuberculosis treatment, the patient accepted lung biopsy by thoracoscopic surgery. HE staining showed that the tumor cells had characteristics of smooth muscle cell differentiation.Immunohistochemical staining showed a low proliferation index of tumor cells, which did not indicate theexistence of pulmonary malignant tumor. Smooth muscle actin ( SMA) and desmin as the specific markers of smooth muscle, estrogen receptor ( ER) and progesterone receptor ( PR) were all bly positive, which was the characteristic of pulmonary benign metastasizing leiomyoma. The patient was given the anti-estrogen tamoxifen for 3 months.Without radiological evidence of disease development and further distant metastasis,the patient had been followed up. Conclusions Pulmonary benign metastasizing leiomyoma is a rare disease which can occur in any age group, particularly prevalent among late childbirth women. All patients have uterine leiomyoma history and/ or myomectomy operation, often associated with uterine metastasis, which commonly occurs in lung.
ObjectivesTo systematically review the perinatal outcomes after laparoscopic myomectomy versus transabdominal myomectomy.MethodsPubMed, Web of Science, Elsevier, The Cochrane Library, CNKI, VIP and WanFang Data databases were searched from inception to July 2017, to collect randomized controlled trials or cohort studies comparing the perinatal outcomes after laparoscopic myomectomy and transabdominal myomectomy. Two reviewers independently screened literature, extracted data and assessed the risk of bias of include studies. Meta-analysis was then performed by RevMan 5.3 software.ResultsEight randomized controlled trials, twenty-one cohort studies involving 4357 patients were included. The results of meta-analysis showed that: the premature birth rate (OR=0.60, 95%CI 0.38 to 0.95, P=0.03) in the laparoscopic myomectomy was lower than that in the laparotomy group. However, the rate of uterine rupture during pregnancy (OR=3.19, 95%CI 1.29 to 7.89, P=0.01) in the laparoscopic myomectomy was higher than that in the laparotomy group. There were no significant differences between two groups in the myoma residual (OR=1.00, 95%CI 0.37 to 2.65, P=0.99), recurrence (OR=0.92, 95%CI 0.68 to 1.25, P=0.60), abortion (OR=0.90, 95%CI 0.63 to 1.28, P=0.56), ectopic pregnancy (OR=1.11, 95%CI 0.54 to 2.26, P=0.78), pregnancy rate (OR=1.06, 95%CI 0.89 to 1.27, P=0.52), cesarean (OR=0.82, 95%CI 0.57 to 1.19, P=0.31), and pregnancy complications (OR=0.84, 95%CI 0.45 to 1.59, P=0.60).ConclusionsCurrent evidence shows that there are no significant differences between two groups in the myoma residual, myoma recurrence, abortion, ectopic pregnancy, pregnancy rate, cesarean and pregnancy complications. While the rate of uterine rupture during pregnancy in the laparoscopic myomectomy is higher than that in the laparotomy group, the premature birth rate after operation in the laparoscopic myomectomy is lower and shorter than that in the laparotomy group. Due to the limited quantity and quality of the included studies, more high quality studies are required to verify the above conclusion.