Objective To systematically evaluate the effectiveness and cost of laparoscopic myomectomy (LM) vs. traditional abdominal myomectomy (TAM) in treating Chinese patients with hysteromyoma. Methods Such databases as The Cochrane Library (Issue 4, 2012), PubMed, EMbase, CNKI, CBM and WanFang Data were searched from their inception to September, 2012 to collect the randomized controlled trials (RCTs) about LM vs. TAM in treating Chinese patients with hysteromyoma, and the references of the included studies were also retrieved. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data and assessed the methodological quality. Then meta-analysis was conducted using RevMan 5.2 software. Results A total of 8 RCTs involving 1 000 Chinese patients were included. The results of meta-analysis showed that, LM was superior to TAM in postoperative exhaust time (WMD= ?15.21, 95%CI ?20.19 to ?10.24, Plt;0.000 01) and postoperative hospital stay (WMD= ?3.07, 95%CI ?4.25 to ?1.90, Plt;0.000 01), with significant differences. But it was inferior to TAM in operation time (WMD=28.33, 95%CI 18.07 to 38.59, Plt;0.000 01) and hospital costs (WMD=2 028.87, 95%CI 1 190.75 to 2 866.98, Plt;0.000 01), with a significant difference. There was no significant difference in intraoperative bleeding amount between the two groups (WMD= ?2.78, 95%CI ?41.56 to 36.00, P=0.89). Conclusion This study shows LM is superior to TAM in fastening postoperative recovery and shortening hospital stay, but it is longer in operation time and higher in cost. The intraoperative bleeding amount is similar in the two groups. Due to low methodological quality and small sample size of the included studies, this conclusion has to be further proved by more high-quality RCTs.
Objective To systematically review the effectiveness and safety of high intensity focused ultrasound (HIFU) for myoma of uterus fibroid. Methods Such databases as PubMed, EMbase, Web of Science, The Cochrane Library (Issue 10, 2012), CBM, CNKI, and WanFang Data were electronically searched from inception to November 2012 for randomized controlled trials on HIFU for myoma of uterus fibroid. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then, meta-analysis was performed using RevMan 5.0 software, and the quality levels of evidence were graded using GRADEpro 3.2 software. Results A total of 6 trials were included, involving 643 patients. The results of meta-analysis showed that, HIFU was similar to surgery in complete and partial fibroid ablation, with no significant difference; HIFU and radiofrequency were different in complete and partial fibroid ablation, with significant differences; and HIFU was superior to mifepristone in complete fibroid ablation, with a significant difference. Conclusion HIFU is an alternative, non-invasive, safe and effective treatment for myoma of uterus fibroid.
Objective To assess the efficacy and safety of Guizhifuling capsule versus western medicine in the treatment of uterine myoma. Methods Randomized controlled trials (RCTs) involving Guizhifuling capsule versus western medicine in the treatment of uterine myoma were identified from CBM (1978 to 2009), VIP (1989 to 2009), WANFANG Database (1998 to 2009), CNKI (1979 to 2009). We also manually searched relevant journals from Tianjin University of Traditional Chinese Medicine. Data were extracted and evaluated by two reviewers independently with a specially designed extraction form. The Cochrane Collaboration’s RevMan 5.0.22 software was used for data analyses. Results A total of 8 trials involving 798 patients were included. The results of meta-analyses showed that, a) the mean uterine myoma volume in the experimental group was different when compared with the mifepristone group (WMD= 0.64, 95%CI 0.56 to 0.71); b) no difference was found between the experimental group and the mifepristone group in serums hormone level, such as, follicle-stimulating hormone (WMD= 2.40, 95%CI –?3.09 to 7.89), luteinizing hormone (WMD= 1.22, 95%CI –?1.05 to 3.49), estriol (WMD= 11.07, 95%CI –?7.70 to 29.84), and P (WMD= 0.52, 95%CI –?0.33 to 1.37); c) As for clinical symptoms effective rate, significant difference was noted between the experimental group and the mifepristone group, such as, menorrhagia (RR= 0.49, 95%CI 0.25 to 0.94), dysmenorrheal (RR= 0.12, 95%CI 0.04 to 0.38), and bellyache and abdominal distension (RR= 0.28, 95%CI 0.12 to 0.62); d) In terms of the total effective rate, significant differences were noted between the experimental group and the mifepristone group (RR= 1.16, 95%CI 1.02 to 1.32); and e) Four trials reported the long-term follow-up results in which the experimental group was better than that in the control group.Conclusion The treatment of uterine myoma by Guizhifuling capsule plus mifepristone is superior to that by mifepristone alone in reducing uterine myoma volume, clinical symptom, and long-term follow-up results. Singly using Guizhifuling capsule is not inferior to western medicine. Further large-scale trials are required to define the role of Guizhifuling capsule in the treatment of uterine myoma.
Objective To evaluate and select essential medicine for uterine neoplasms using evidence-based methods based on the burden of disease. Methods By means of the approaches, criteria, and workflow set up in the second article of this series, we referred to the recommendations of evidence-based or authority guidelines from inside and outside China, collected relevant evidence from domestic clinical studies, and recommended essential medicine based on evidence-based evaluation. Data were analyzed by Review Manager (RevMan) 5.1 and GRADE profiler 3.6 to evaluate quality of evidence. Results (1) Six guidelines were included, three of which were evidence-based. (2) Retrieved guidelines related to nine medicines (of three classes) for uterine neoplasms and five adjuvant drugs (of three classes) used after relevant surgery. (3) According to WHOEML (2011), NEML (2009), CNF (2010), other guideline and the quantity and quality of evidence, we offered a b recommendation for medroxyprogesterone acetate, oxytocin, ergometrine and a weak recommendation for testosterone propionate, methyltestosterone, tamoxifen, mifepristone, tranexamic acid, leonurus heterophyllus used in the treatment of uterine neoplasms. We offered a recommendation against danazol and aromatase inhibitors. (4) We found relevant domestic literature on mifepristone, methyltestosterone, tamoxifen, oxytocin and leonurus heterophyllus. Mifepriston combined with methyltestosterone or tamoxifen was recommended to use as a conservative therapy for uterine neoplasms. Oxytocin,and leonurus heterophyllus were used to reduce bleeding after the surgery of uterine neoplasms. As to daily expense, mifepriston (25 mg/d) cost 13.0 to 27.5 yuan, methyltestosterone (5 mg/d) 0.074 yuan, tamoxifen (20 mg/d) 0.6 to 1.4 yuan, leonurus heterophyllus (injection, 1 mL) 15 yuan and oxytocin (injection, 20 U) 1.5 yuan. (5) Results of domestic studies indicated that mifepristone, mifepristone plus methyltestosterone, and mifepristone plus tamoxifen were proved to be safe and applicable for the treatment of uterine neoplasms. Oxytocin and leonurus heterophyllus are effective in preventing postoperative bleeding and the combination of two effectively and safely promoted uterine contraction. Conclusion (1) We offer a recommendation for three medication plans used in the treatment uterine neoplasms during perimenopause, including: a) Mifepristone (25 mg/ tablet, once daily); b) Mifepristone (25 mg/ tablet, once daily) plus methyltestosterone (5 mg/tablet, once daily); c) Mifepristone (25 mg/ tablet, once daily) plus tamoxifen (10 mg/tablet, twice daily). The three plans mentioned above should be used from first day of menstrual cycle, continuously for three months. (2) Adjuvant drugs such as oxytocin (injection, 1 to 2 mL) and leonurus heterophyllus (injection, 10 U) can be applied to reduce vaginal bleeding flow after the surgery of uterine neoplasms. (3) Personnel in elementary healthcare institution should stick to drug indication, carefully make follow-up, and dynamically monitor the change of uterine neoplasms and menstruation so as to adjust medication plan according to patients’ situation.
(1)子宫肌瘤的单独药物治疗:①单独应用促性腺激素释放激素类似物:RCT发现,与安慰剂相比,GnRHa(gonadorelin analogues)可改善子宫肌瘤的症状,但副作用较大.其中1个研究表明,与安慰剂相比,达菲林在治疗12周时能明显增加闭经;另1个系统性回顾研究显示,无充分证据证实达菲林和布舍瑞林疗效的优劣.1个RCT发现,达菲林高剂量治疗较低剂量治疗在治疗16周时显著增加闭经.两个RCT发现,达菲林与安慰剂相比,在治疗16周后能显著减少骨密度,但治疗停止6个月后,骨密度可以回升到治疗前水平.两个RCT发现,与安慰剂和布舍瑞林相比,达菲林引起的潮热显著增加.②GnRHa联合雌/孕激素:1个小样本RCT比较了GnRHa+雌/孕激素和GnRHa+孕酮改善子宫肌瘤症状的效果的差异,但这些证据很不充分.③GnRHa+孕酮:1小样本RCT发现,与单独使用醋酸亮丙瑞林治疗相比,醋酸亮丙瑞林加孕酮能显著减少出血过多.两个小样本RCT发现,与单独应用GnRHa相比,GnRHa+孕酮能显著减少潮热.④GnRHa+7-甲异炔诺酮:小样本RCT发现,在子宫、子宫肌瘤大小及症状改善方面,单独使用GnRHa和GnRHa+7-甲异炔诺酮比较,无显著差异.⑤非类固醇抗炎药物:两个小样本RCT发现,无充分证据显示非类固醇抗炎药物对子宫肌瘤引起的月经过多有效果.⑥孕三烯酮、左炔诺孕酮宫内系统、米非司酮:无RCT.(2)子宫肌瘤的手术前药物治疗:GnRHa:1项系统回顾研究和1个RCT发现,与安慰剂或不治疗相比,术前使用GnRH-a 3个月以上能增加患者血红蛋白和红细胞压积,减轻子宫和盆腔症状及术中出血.术前应用GnRHa后,更适合经阴道而不是经腹子宫切除.然而术前用药妇女往往会有低雌激素所带来的副效应.(3)子宫肌瘤的手术治疗效果:①经腹子宫切除:无RCT.但一致认为子宫切除对改善子宫肌瘤症状有效.②腹腔镜协助下经阴道子宫切除:无RCT比较此方法与其他方法的长期效果.1个小样本RCT发现,仅有限的证据表明此种方法比经腹子宫切除恢复快、术后疼痛轻.③腹腔镜下肌瘤切除(对比经腹肌瘤切除):1项RCT表明,前者比后者的术后疼痛轻、恢复快.④热球子宫内膜切除术:无RCT比较此方法与非手术治疗及子宫切除之间的效果.有1个RCT比较了术前应用GnRHa,且子宫肌瘤小于孕12周子宫大小的病例中此方法与滚珠子宫内膜去除方法.在子宫切除率、闭经率、流血图表估计得分或治疗12个月时的血红蛋白方面,二者没有差别.与滚珠子宫内膜去除相比,热球子宫内膜去除术减少了操作时间及术中并发症.据报道,大约有1/3的妇女不十分满意滚珠子宫内膜去除术和热球子宫内膜去除术二者中的任何一种方法.
【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.
ObjectiveTo explore the prevalence rate of gynecologic diseases and its character of age distribution of women in Chengdu, China. MethodsWe retrospectively analyzed gynecologic examination reports of women who underwent physical examination from December 2011 to November 2012. ResultsThis study included 23 389 women; the overall detection rate of cervix erosion was 20.98%. The detection rate of cervix erosion of women aged from 20 (included) to 30 was 44.81%, ranking first. The overall rate of abnormal cervical cytology was 0.93%, and the rate of women aged 41 to 50 was 1.20%, ranking first. The overall detection rate of uterine myoma, uterine adenomyosis, and ovarian tumor was 11.12%, 1.33%, and 3.60%, respectively. Fourty-one to 50 was the peak age of uterine myoma, uterine adenomyosis, and ovarian tumor; the detection rate was 19.95%, 2.46%, and 4.76%, respectively. The difference was significant in different age (P<0.05). ConclusionThe detection rate of gynecological common disease is high in childbearing aged women. Women aged 41-50 is the high-risk population of gynecological common disease.
ObjectiveTo probe into the clinical efficacy of high-intensity focused ultrasound (HIFU) alone for uterine fibroids. MethodBetween February 2012 and February 2014, 145 patients with 174 cases of uterine fibroids were treated with HIFU. Before and one day, 6 months, 12 months after treatment, MRI was performed during the follow-up. We analyzed fibroids narrowing rate, adverse reactions, and clinical symptoms improvement after treatment. ResultsSuccessful completion of HIFU ablation was done for all the fibroids. Enhanced MRI examination before and one day after treatment, and MRI plain scanning 6 and 12 months after treatment showed that fibroid volume before treatment was 4.61-419.70 cm3 (median of 56.82 cm3), fibroid volume after treatment was 3.02-578.21 cm3 (median of 56.74 cm3), ablation volume was 2.42-578.21 cm3 (median of 47.84 cm3), and volumetric ablation rate was 24%-100%; there was no statistically significant difference in fibroid volume before and after treatment (P>0.05); fibroid volume 6 months after treatment was 0-264.50 cm3 (median of 22.49 cm3) and was 0-346.02 cm3 (median of 14.81 cm3) 12 months after treatment with a reduction rate of 60.4% and 73.9% on average respectively, and the volume was significantly different between those two time points and before treatment (P<0.05), and between 6 months and 12 months after treatment (P<0.05). The medians of uterine fibroid symptoms (UFS) and quality of life (QOL) scores before ablation were respectively 21.88 and 71.55 points. UFS reduced by 57.1% and 71.4% respectively 6 and 12 months after ablation, and QOL increased by 15.7% and 26.5% at those two time points. Both UFS and QOL 6 and 12 months after treatment were significantly different from that before treatment (P<0.05), and the UFS and QOL difference between 6 months and 12 months after treatment was also significant (P<0.05). As time went on, UFS gradually reduced, while QOL gradually increased. Complication rate was 2.8% with two cases of skin shallow degree-Ⅱ thermal damage, one of lower limb radiation pain, one of urinary retention, and there were 6 cases of recurrence during the follow-up. ConclusionsHIFU treatment for uterine fibroids is safe and effective, and is an alternative choice for conventional treatment when it is unable to retain the womb or when the patient refuses surgical treatment.
Vascular perfusion distribution in fibroids contrast-enhanced ultrasound images provides useful pathological and physiological information, because the extraction of the vascular perfusion area can be helpful to quantitative evaluation of uterine fibroids blood supply. The pixel gray scale in vascular perfusion area of fibroids contrast-enhanced ultrasound image sequences is different from that in other regions, and, based on this, we proposed a method of extracting vascular perfusion area of fibroids. Firstly, we denoised the image sequence, and then we used Brox optical flow method to estimate motion of two adjacent frames, based on the results of the displacement field for motion correction. Finally, we extracted vascular perfusion region from the surrounding background based on the differences in gray scale for the magnitude of the rich blood supply area and lack of blood supply area in ultrasound images sequence. The experimental results showed that the algorithm could accurately extract the vascular perfusion area, reach the precision of identification of clinical perfusion area, and only small amount of calculation was needed and the process was fairly simple.