Obstetrics & gynecology science

Korean Society of Obstetrics and Gynecology (대한산부인과학회)
권호 표지

A clinical study of vaginal myomectomy

질식 자궁근종절제술의 임상적 고찰

Chang, Eu-Gene;Lee, So-Myung;Cho, Hye-Yeon;Park, Seo-Yeon;Kim, Eun-Kyoung;Kang, Woo-Dae;Kim, Jong-Woon;Kim, Seok-Mo;Choi, Ho-Sun
장유진;이소명;조혜연;박서연;김은경;강우대;김종운;김석모;최호선

  • Published : 20080900
⟨ Previous Next ⟩

Abstract

Objective: The aim of this study was to evaluate the clinical effectiveness and safety of vaginal myomectomy via colpotomy with analyzing clinical course and postoperative complication. Methods: A retrospective study was performed in 59 patients, who underwent vaginal myomectomy between November 1997 and July 2006 in department of gynecology, Chonnam National University Hospital. Operating time, hemoglobin change, postoperative pain, perioperative complication, and days of hospital stay were recorded. Results: Fifty-nine patients were evaluated, mean age of patients was 41.54±5.8 years. Mean diameter of the uterine myoma was 6.79±1.75 cm. Mean operating time was 66.69±34.49 minute. Mean hemoglobin loss was 2.67±1.26 g/dL, and mean days of hospital stay was 4.91±1.25 days. One patient had febrile morbidity. Only one patient had suffered from retroperitoneal bleeding enough to get on operation. Conclusion: Vaginal myomectomy seems to be a feasible and safe surgical procedure. Further randomised studies are needed to compare this procedure with laparotomy and laparoscopy, and vaginal myomectomy is expected to be more effective and generalized surgical procedure.

목적: 질식 자궁근종절제술을 시행한 환자를 대상으로 임상 경과 및 수술 후 합병증 여부를 분석하여 질식 근종절제술의 유용 성 및 안정성에 대해 알아보고자 하였다. 방법: 1997년 11월부터 2006년 7월까지 전남대학교 병원에서 질식 자궁근종절제술을 시행한 59명의 환자를 대상으로 수술시 간, 혈색소 변이, 수술 후 통증, 수술 후 합병증, 수술 후 입원기간에 대해 후향적 고찰을 하였다. 결과: 59명 환자의 평균 연령은 41.54±5.8세였고, 근종의 평균 크기는 6.79±1.75 cm였다. 평균 수술시간은 66.69±34.49분이었고 수술 후 평균 혈색소 감소량은 2.67±1.26 g/dL. 술후 24시간 이후에 38℃ 이상의 발열을 보인 경우는 1명이었으며, 술후 후복 막내 출혈로 재수술을 했던 경우가 1명이었다. 평균 입원기간은 4.91±1.25일이었다. 결론: 질식 근종절제술은 유용하고 안전한 수술방법이다. 개복을 통한 근종절제술과 복강경하 근종절제술을 본 연구 결과와 비교하여 질식 근종절제술의 임상적 유용성을 더 연구할 필요가 있으며 질식 근종절제술이 보다 대중화되고 효과적인 수술 방법이 될 것을 기대한다.

Keywords

References

  1. Cramer SF, Patel A. The frequency of uterine leiomyomas. Am J Clin Pathol 1990; 94: 435-8 https://doi.org/10.1093/ajcp/94.4.435
  2. Buttram VC Jr, Reiter RC. Uterine leiomyomata: etiology symptomatology, and management. Fertil steril 1981; 36: 433-45 https://doi.org/10.1016/S0015-0282(16)45789-4
  3. Lumsden MA. Embolization versus myomectomy versus hysterectomy: Which is best, when? Hum Reprod 2002; 17: 253-9 https://doi.org/10.1093/humrep/17.2.253
  4. Verkauf BS. Myomectomy for fertility enhancement and perservation. Fertil Steril 1992; 58: 1-15 https://doi.org/10.1016/S0015-0282(16)55128-0
  5. Nezhat C, Nezhat F, Schiffer N, Silfen SL, Evans D. Laparoscopic myomectomy. Int J Fertil 1991; 36: 275-80
  6. Daniell JF, Guerly LD. Laparoscopic treatment of clinically significant symptomatic uterine fibroids. J Gynecol surg 1991; 7: 37-40 https://doi.org/10.1089/gyn.1991.7.37
  7. Hasson HM, Rotman C, Rana N, Sistos F, Dmowski WP. Laparoscopic myomectomy. Obstet Gynecol 1992; 80: 884-8
  8. Dubuisson JB, Chapron C, Mouly M. Laparoscopic myomectomy. Gynecol Endosc 1993; 2: 171-3
  9. Darai E, Dechaud H, Benifla JL, Renolleau C, Panel P, Madelenat P. Fertility after laparoscopic myomectomy: preliminary results. Hum Reprud 1997; 12: 1931-4 https://doi.org/10.1093/humrep/12.9.1931
  10. Broekmans FJ. GnRH agonist and uterine leiomyomas. Hum Reprod 1996; 11 Suppl 3: 3-25
  11. Goldfarb HA. Nd:YAG laser laparoscopic coagulation of symptomatic myomas. J Reprod Med 1992; 37: 636-8
  12. Goodwin SC, Vedantham S, McLucas B, Forno AE, Perrella R. Preliminary experience with uterine artery embolization for uterine fibroids. J Vasc Interv Radiol 1997; 8: 517-26 https://doi.org/10.1016/S1051-0443(97)70603-1
  13. LaMorte AI, Lalwani S, Diamond MP. Morbidity associated with abdominal myomectomy. Obstet Gynecol 1993; 82: 897-900
  14. Corson SL, Brooks PG. Resectoscopic myomectomy. Fertil Steril 1991; 55: 1041-4 https://doi.org/10.1016/S0015-0282(16)54349-0
  15. Mais V, Ajossa S, Guerriero S, Mascia M, Solla E, Melis GB. Laparoscopic versus abdominal myomectomy: a prospective, radomized trial to evaluate benefits in early outcome. Am J Obstet Gynecol 1996; 174: 654-8 https://doi.org/10.1016/S0002-9378(96)70445-3
  16. Alessandri F, Lijoi D, Mistrangelo E, Ferrero S, Raqni N. Randomized study of laparoscopic versus minilaprotomic myomectomy for uterine myomas. J Minim Invasive Gynecol 2006; 13: 92-7 https://doi.org/10.1016/j.jmig.2005.11.008
  17. Birsan A, Deval B, Detchev R, Poncelet C, Darai E. Vaginal and laparoscopic myomectomy for large posterior myomas: results of a pilot study. Eur J obstet Gynecol Reprod Biol 2003; 110: 89-93 https://doi.org/10.1016/S0301-2115(03)00087-3
  18. 정언석, 위혜정, 윤호진, 경민선, 이교원, 한종설, 등. 다양한 크기의 자궁근종 110예에 대한 복강경하 자궁근종절제술의 임상적 효용성에 대한 고찰. 대한산부회지 2007; 50: 918-25
  19. 김형태, 박성환, 박훈량, 장홍준, 김철, 김주원, 등. 복식 자궁근종절제술의 안정성과 유용성에 대한 고찰. 대한산부회지 2003; 46: 132-7
  20. Plotti G, Plotti F, Di Giovanni A, Battagia F, Nagar G. Feasibility and safety of vaginal myomectomy; a prospective pilot study. J Minim Invasive Gynecol 2008; 15: 166-71 https://doi.org/10.1016/j.jmig.2007.09.010
  21. 송수진, 김철호, 김성희, 박은영, 박근식, 문화숙. 내시경하 자궁근종절제술의 Learning curve. 대한산부회지 2003; 46: 2341-51
  22. 이승열, 류현호, 이춘보, 주은현, 김성경, 송치훈, 등. 골반경하 자궁근종절제술 93예의 임상적 고찰. 대한산부회지 2004; 47: 1107-12
  23. Zhang J, Huang L, Chen YH, Zhang KJ, Zhu LC, Gao SY. Clinical analysis of 45 cases of vaginal myomectomy. Zhonhua Fu Chan Ke Za Zhi. 2005; 40: 659-61
  24. Agostini A, Gerbeau S, Al Nakid M, Ronda I, Cravello L, Blanc B. Complications of vaginal myomectomy by posterior colpotomy. Eur J Obstet Reprod Biol 2008; 138: 100-4 https://doi.org/10.1016/j.ejogrb.2007.06.016
  25. Davies A, Hart R, Magos AL. The excision of uterine fibroids by vaginal myomectomy, a prospective study. Fertil Steril 1999; 71: 961-4 https://doi.org/10.1016/S0015-0282(99)00061-8
  26. Magos AL, Bournas M, Sinha R, Richardson RE, O'Connor H. Vaginal myomectomy. Br J Obstet Gynecol 1994; 101: 1092-4 https://doi.org/10.1111/j.1471-0528.1994.tb13593.x
  27. Pelosi MA 3rd, Pelosi MA. Laparoscopic-assisted transvaginal myomectomy. J Am Assoc Gynecolo Laparosc 1997; 4: 241-6 https://doi.org/10.1016/S1074-3804(97)80017-5
  28. Wang CJ, Yen CF, Lee CL, Soong YK. Laparoscopic-asscisted vaginal myomectomy. J Am Assoc Gynecol Laparosc 2000; 7: 510-4 https://doi.org/10.1016/S1074-3804(05)60364-7
  29. Dubuisson JB, Chavex X, Chapron C, Gregorakis SS, Morice P. Uterine rupture during pregnancy after laparoscopic myomectomy. Hum Reprod 1995: 10: 1475-7
  30. Landi S, Zaccoletti R, Ferrari L, Minelli L. Laparoscopic myomectomy: technique, complication, and ultrasound scan evaluation. J Am Assoc Gynecol Laparosc 2001; 8: 231-40 https://doi.org/10.1016/S1074-3804(05)60583-X