Obstetrics & gynecology science

Korean Society of Obstetrics and Gynecology (대한산부인과학회)
권호 표지

Safty and Usefulness of Abdominal Myomectomy

복식 자궁근종 절제술의 안정성과 유용성에 대한 고찰

Kim, Hyung-Tae;Park, Sung-Hwan;Park, Hoon-Ryang;Jang, Hong-Joon;Kim, Chul;Kim, Joo-Woen;Hyung, Nam-Gyu
김형태;박성환;박훈량;장홍준;김철;김주원;형남규

  • Published : 20030100
⟨ Previous Next ⟩

Abstract

Objective : To report a safe and minimal bleeding procedure of abdominal myomectomy and to assess perioperative morbidity associated with this procedure. Methods : From January 1998 to April 2000, We Studies 33 gynecologic patients undergoing abdominal myomectomy at department of obstetrics and gynecology, Choon-Hae Hospital, retrospectively. Particular attention was given to intraoperative estimated blood loss, blood transfusion requirement and the febrile morbidity rate. Results : Myomectomy was performed successfully in all patients for whom it was scheduled. Mean intraoperative estimated blood loss was 211.5${\pm}$91.3 mL. Four cases (12%) had an estimated blood loss greater than 400 mL. Preoperative, intraoperative or postoperative transfusion occurred in 6 cases (18%). There were no other intraoperative complications. Febrile morbidity occurred in 6 (18%) cases. Two cases (6%) experienced wound infection. Conclusion : We conclude that this procedure is safe and appropriate alternative for most women who want to preserve or enhance fertility potential.

목적 : 복식 근종 절제술을 시행한 환자들을 후향적 연구를 통해 수술의 안정성과 유용성에 대해 알아보고자 하였다. 연구 방법 : 1998년 1월부터 2000년 4월까지 춘해병원 산부인과에서 복식 근종 절제술을 시행한 환자 33명의 외래 및 입원 기록을 검토하여 환자의 연령, 출산력, 증상, 수술시 출혈량, 수술합병증 등을 분석하였다. 결과 : 모든 환자에서 예정대로 복식 근종절제술이 시행되었으며, 수술시 평균 출혈량은 211.5${\pm}$91.3 mL 이었고, 6 cases (18%)에서 수혈을 하였다. 다른 수술 중 합병증의 발생은 없었고, 수술 24시간 이후 열이 발생한 경우는 6 cases (18%)였다. 2 cases (6%)에서 수술 상처부위의 감염이 있었다. 결론 : 복식 근종절제술은 자궁을 보존하길 원하거나 향후 임신을 원하는 환자에 있어서 수행할 수 있는 안전하고 유용한 방법으로 사료된다.

Keywords

References

  1. Novak ER, Woodruff JD. Myoma and other benign turners of the uterus. In Gynecologic and Obstetric Pathology. Eighth ed. Philadelphia WB Saunders. 1979; 260.
  2. Wallach EE. Myomectomy. In: Tompson JD, Rock JA, editors. TeLinde's operative gynecology. Philadelphia: JB Lippincott; 1992. P. 647-61.
  3. American College of Obstetricians and Gynecologists. Uterine leiomyomata. Washington: The College; 1994. P. 1-9. ACOG Technical Bulletin No. 192.
  4. Iverson RE Jr, Chelmow D, Strohbehn K, Waldman L, Evantash EG. Relative morbidity of abdominal hysterectomy and myomectomy of management of uterine leiomyomas. Obstet Gynecol 1996; 88: 415-9. https://doi.org/10.1016/0029-7844(96)00218-9
  5. Stephen W, Nicole D, Jesse A, Kurt T. Comparability of perioperative morbidity between abdominal myomectomy and hysterectomy for women with uterine leiomyoma. Am J Obstet Gynecol 2000; 183: 1448-55. https://doi.org/10.1067/mob.2000.107730
  6. Smith DC, Uhlir JK. Myomectomy as a reproductive procedure. Am J Obstet Gynecol 1990; 162: 1476-82. https://doi.org/10.1016/0002-9378(90)90909-Q
  7. Buttram VC, reitter RC Uterine leiomyomata: etiology,symptomatology and management Fertil Steril 1981; 36: 433-45.
  8. Miller NF, Ludovici PP. Origin and development of uterine fibroid. Am J Obstet Gynecol 1955; 70: 720-40.
  9. Dawood MY, Sabir N. Growth factors and leiomyoma. Infertility and Reproductive Medicine Clinics of North America. 1996; 1: 5-18.
  10. Corson SL, Brooks PG. Resectoscopic myomectomy. Fertil Steril 1991; 55: 1041-4.
  11. Hassan HM, Rotman C, Rana N, Sistos F, Demowski P. Laparcscopic myomectomy. Obstet Gynecol 1992; 79: 884-8.
  12. Harris WJ. Uterine dehiscence following laparoscopic myomectomy. Obstet Gynecol 1992; 80: 545-6.
  13. Verkauf BS. Changing trends in treatment of leiomyomata uteri. Curr Opin Obstet Gynecol 1993; 5: 301-10.
  14. Rubin IC Progress in myomectomy. Am J Obstet Gynecol 1942; 44: 196-212.
  15. Dillon TF. Control of blood loss during gynecologic surgery. Obster Gynecol 1962; 19: 428-35.
  16. Fletcher H, Frederic J, Hardie M, Simeon D. A randomised comparison of vasopressin and tourniquet as hemostatic agents during myomectomy. Obstet Gynecol 1996; 87: 1014-8. https://doi.org/10.1016/0029-7844(96)00071-3
  17. Ginsburg ES, Benson CB, Garfield JM, Gleason RE, Friedman AJ. The effect of operative technique and uterine size on blood loss during myomectomy: a prospective randomised study. Fertil Steril 1993; 60: 956-62.
  18. Acien P, Quereda F. Abdominal myomectomy: results of a simple operative technique. Fertil Steril 1996; 65: 41-51.
  19. Fedele L, Vercellini P, Bianchi S, Brioschi D, Dorta M. Treatment with GnRH agonists before myomectomy and the risk of short-term myoma recurrence. British J Obstet Gynecol 1990; 97: 393-6. https://doi.org/10.1111/j.1471-0528.1990.tb01824.x
  20. LaMorte AI, Lalwani S, Diamond MP. Morbidity associated with abdominal myomectomy. Obstet Gynecol 1993; 82: 897-900.
  21. Sawin SW, Pilevsky ND, Berlin JA, Barnhart KT. Comparability of perioperative morbidity between abdominal myomectomy and hysterectomy for women with uterine leiomyomas. Am J Obstet Gynecol 2000; 183: 1448-55. https://doi.org/10.1067/mob.2000.107730
  22. Verkauf BS: Myomectomy for fertility enhancement and preservation. Fertil Steril 1992; 58: 1-15.
  23. Charles E. Myomectomy: Comparison of open and laparoscopic techniques. Obstet Gynecol Clin North Am 2000; 27: 407-20. https://doi.org/10.1016/S0889-8545(00)80031-5
  24. West CP. Hysterectomy and myomectomy by laparotomy. Bailliere's Clinical Obstetrics and Gynecology 1998; 12: 317-35. https://doi.org/10.1016/S0950-3552(98)80066-7
  25. Mais V, Ajossa S, Piras B, Guerriero S, Marongiu D, Melis GB. Prevention of de-nove adhesion formation after laparoscopic myomectomy: A randomized trial to evauate the effectiveness of an oxidized regeneratedcellulose absorbable barrier. Hum Reprod 1995; 10: 3133-5.