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World Journal of Clinical Cases 2020年第1期8卷 188-193页

作者： Yong Zhou Zheng-Yun Chen Xin-Mei Zhang Department of Gynecology Women’s HospitalZhejiang University School of Medicine

BACKGROUND A cystic lesion arising from the myometrium of the uterus, termed as cystic adenomyosis, has chocolate-like, thick viscous contents and contains various amounts of endometrial stroma below the glandular epithelium. It is an extremely rare type of *** SUMMARY Herein, we report an unusual case of a giant cystic mass in the pelvic cavity after uterine myomectomy. The patient complained of abnormal uterine bleeding and severe dysmenorrhea. After a levonorgestrel-containing intrauterine device(LNG-IUD) was inserted, her symptoms were greatly alleviated. However, the LNG-IUD was detected in the cystic cavity during the follow-up. For fear of the intrauterine device migrating into and damaging the surrounding viscera,surgical treatment was proposed. Therefore, laparoscopic resection of the lesion and removal of the LNG-IUD were performed and cystic adenomyosis with an LNG-IUD out of the uterine cavity was *** We believe that myomectomy breaking through the endometrial cavity may have been a predisposing factor for the development of cystic adenomyosis in this case.

关键词： Cystic adenomyosis Dysmenorrhea Levonorgestrel containing intrauterine device myomectomy Case report

LAPAROSCOPIC myomectomy

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Chinese Medical Sciences Journal 2001年第2期16卷 111-114页

作者：冷金花郎景和刘珠凤黄荣丽 Department of Obstetrics and Gynecology Peking Union Medical College Hospital CAMS &amp

Objective. To investigate the indications, surgical techniques and complications of laparoscopic myomectomy. Materials and methods. A retrospective study was carried out in 74 patients with fibroids >3cm from March, 1995 until May,2000 at PUMC Hospital. Indications for surgery were symptomatic fibroids（ 20 cases） , mainly pain or urine frequency； progressively increasing fibroid size (7 cases)； coexistent adnexal pathology（ 26 cases） and infertility（ 21 cases） . Results. The number of fibroids of each patient varied from 1 to 4 with single fibroid of 62 cases (83.7％ ).The fibroids were located in anterior wall (30 cases), posterior wall (23 cases) and fundus (21 cases). A total of 93 fibroids were removed from these patients including 16 intramural fibroids and 77 subserous fibroids. The size of dominant fibroids ranged from 3～ 8 cm (mean 4.8 cm). In 19 cases (25.6％ ),the uterine wall was sutured in one layer. Mean duration of operation was 73 minutes and mean blood loss was 82 ml. Longer operating time and more blood loss were observed in patients with fibroids≥ 4cm than those with fibroids myomectomy was given to her successfully. Five patients became pregnant. The pregnancy was uneventful and proceeded to selective caesarean section at term pregnancy in 4 cases. One miscarriage occured at 8 weeks in the 5th case. No adhesions at myomectomy site were found in these 5 patients. Conclusions. Our study suggests the feasibility of laparoscopic myomectomy in selected patients, which leads to effectiveness, low complication rate and satisfactory remission of symptom

关键词： laparoscopy myomectomy complication

Myometrial smooth muscle cells spillage during open myomectomy:Is it True or a myth?

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Gynecology and Obstetrics Clinical Medicine 2021年第4期1卷 216-219页

作者： L.Giambanco V.Iannone D.Messina M.Borriello F.D'Amico Ob&Gyn Department S.Antonio Abate HospitalTrapaniItaly Pathology Unit S.Antonio Abate HospitalTrapaniItaly

Background:Uncontained morcellation of myoma during laparoscopic surgery has been discouraged because of unknown *** the safety of contained morcellation has been questioned because muscle cells have been detected in washings obtained during laparoscopic *** possibility of myoma cell dissemination has been observed in open abdominal surgery,even after *** myomectomy would be unsafe from an oncological point of view,regardless of surgical ***:This is an observational cohort study involving 30 patients who underwent open abdominal *** abdominal washings were obtained two times during the open abdominal myomectomy:before uterus incision and after the myomectomy ***,cell block,and immunohistochemical evaluations were ***:All washings obtained immediately after abdominal peritoneal cavity opening were negative for fibroid *** the first and second washings were free of myoma *** evaluation did not reveal any smooth muscle *** results of desmin and smooth muscle actin staining,performed on the pre-and postmyomectomy samples,were ***:Our results demonstrated,for the first time to our knowledge,that there is no dissemination of myoma cells during conservative abdominal *** could represent an additional oncological *** data are needed.

关键词： myomectomy Muscle cells dissemination Laparoscopy Abdominal myomectomy Washings Morcellation

A comparative analysis of spontaneous fertility after myomectomy by laparotomy associated or not with a“second look”laparoscopy

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Laparoscopic, Endoscopic and Robotic Surgery 2019年第2期2卷 27-30页

作者： Etienne Belinga Daniel Antony Bikak Djima Bruno Ela Ondo Esther Juliette Ngo Um Meka Emile Telesphore Mboudou Pascal Foumane Department of Obstetrics and Gynecology Faculty of Medicine and Biomedical Sciencesthe University of Yaounde ICameroon Higher Institute of Health Sciences University of the MountainsCameroon Department of Epidemiology Higher Institute of Health SciencesUniversity of the MountainsCameroon

Objective:The importance of a“second look”laparoscopy for adhesion formation after myomectomy by laparotomy in improving fertility is not clearly defined in our *** aim of this study was to compare spontaneous fertility after myomectomy by laparotomy between women who underwent a“second look”laparoscopy and those who did ***:We conducted an analytical cross-sectional study with retrospective data collection from January 1,2008 to December 31,2015,comparing spontaneous fertility between patients who underwent“second-look”laparoscopy after myomectomy by laparotomy to those who did ***,data was collected from the records of patients included in the ***,through phone calls,informed consent for each participant was obtained after which inquiries were made regarding their fertility ***:After a period of 24 months,23 patients(47.9%)with“second look”laparoscopy conceived,compared to 37 patients(35.2%)without“second look”laparoscopy(p=0.136);and 24 patients(50.0%)with“second look”had term pregnancies compared to 39 patients(37.1%)without“second look”laparoscopy(p=0.134).Conclusion:Spontaneous fertility rates seemed to be improved after a“second look”laparoscopy,however,there was no statistically significant difference between spontaneous fertility rates obtained after myomectomy by laparotomy,irrespective of the fact that the patient had undergone a“second look”laparoscopy or not at Yaounde Gyneco-Obstetric and Pediatric Hospital.

关键词： myomectomy Laparotomy Infertility Adhesions “Second look”laparoscopy

Benefits and Limitations of Laparoscopic myomectomy

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Open Journal of Obstetrics and Gynecology 2019年第3期9卷 292-301页

作者： Silwal Bal Mukunda Yang Shen Shrestha Sugandha Department of Obstetrics and Gynecology Zhongda Hospital Affiliated to Southeast University Nanjing China

Uterine fibroids (also called leiomyoma or myoma) are the most common benign tumor among women of childbearing age. These are often discovered during bimanual examinations and/or ultrasound examinations. Laparoscopic myomectomy offers several benefits to patients such as less blood loss during operation, quick postoperative recovery and shorter hospital stay in comparison to open myomectomy. It has been widely used over the past decades as possible alternative to the traditional laparotomy. In spite of several benefits laparoscopic myomectomy has certain drawbacks such as prolonged time of anesthesia, time consuming procedure, comparatively expensive and weak strength of the uterine scar. Furthermore laparoscopic myomectomy is technically challenging procedure so it requires high degree of training and skill to perform it. Due to its several advantages, it should be taken into consideration for the removal of uterine fibroids.

关键词： Laparoscopic myomectomy Recurrence Uterine Rupture Adhesion Open myomectomy Uterine Fibroid

Faster Healing Process by Sparing Intramural Myoma’s Pseudocapsule during Laparoscopic myomectomy Compared with Removing It during Open myomectomy

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International Journal of Clinical Medicine 2021年第10期12卷 424-432页

作者： Athanasios Zikopoulos Yannis Prapas Maria Paraskevaidi Charalampos Siristatidis Apostolia Galani Orestis Tsonis Minas Paschopoulos Konstantinos Zikopoulos Efstratios Kolibianakis Department of Obstetrics and Gynaecology Royal Cornwall Hospital Cornwall UK IAKENTRO Infertility Treatment Centre Thessaloniki Greece Institute of Reproductive and Developmental Biology Department of Metabolism Digestion and Reproduction Faculty of Medicine Imperial College London London UK Second Department of Obstetrics and Gynaecology/Assisted Reproduction Unit Faculty of Medicine Aretaieion Hospital National and Kapodistrian University of Athens Athens Greece Department of Obstetrics and Gynaecology Royal Preston Hospital Preston UK Department of Obstetrics and Gynaecology/Assisted Reproduction Faculty of Medicine University of Ioannina Ioannina Greece Unit for Human Reproduction 1st Department of Obstetrics and Gynaecology Medical School Aristotle University of Thessaloniki Thessaloniki Greece

Uterine fibroids are the most common benign tumours in the reproductive system. They are proliferations of smooth muscle cells of the myometrium containing a large quantity of extracellular matrix and they are surrounded by a pseudo capsule of compressed areolar tissue and smooth muscle cells. They can cause various symptoms such as menorrhage, pain and infertility and therefore they can be a traumatic experience for several women. The treatment of choice is myomectomy. In the past, myomectomy was performed by relatively atraumatic techniques, which involved stretching the myoma from its pseudocapsule to extract the fibroid directly from the surrounding fibromuscular tissue, breaking up the fibrous bridge. Modern laparoscopic intracapsular myomectomy (LIM), however, leaves the fibrovascular network surrounding the myoma (namely the “fibroid neurovascular bundle”) intact which reduces the bleeding and/or uterine musculature trauma, and spares the neuropeptide fibers of the pseudocapsule. In this observational study, we compare the two techniques-laparoscopic intracapsular myomectomy (LIM) and conventional abdominal myomectomy (CAM) regarding the longterm uterine healing and a significantly faster healing process of the uterine incision was achieved by LIM compared to CAM.

关键词： myomectomy Laparoscopic Intracapsular myomectomy Healing

Laparoscopic versus Abdominal myomectomy: Surgical and Post-Operative Outcomes in CHRACERH-Yaounde

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Open Journal of Obstetrics and Gynecology 2019年第12期9卷 1595-1603页

作者： Noa Ndoua Claude Cyrille Belinga Etienne Wirwah Tardzenyuy Festus Mangala Nkwele Fulbert Kasia Jean Marie Faculty of Medicine and Biomedical Sciences of the University of Yaounde 1 Yaounde Cameroon Gynaecological Endoscopic Surgery and Human Reproduction Teaching Hospital Yaounde Cameroon General Hospital of Douala Douala Cameroon

Introduction: Fibroid benign tumour of the uterus can be operated either by laparotomy or laparoscopy. Laparoscopy is not well vulgarised in our settings. Objective: The main objective was to compare the surgical and post-operative outcomes of laparoscopic versus abdominal myomectomy. Methods: We performed a comparative analytical cross sectional study from 1st January 2016 to 31st March 2018 consisted of two groups: group 1 of women who underwent laparoscopic myomectomy (LM) and group 2 of women who underwent abdominal myomectomy (AM). The data collected was entered in Epi Info 7.2 version and exported to IBM SPSS Statistics version 22 for analysis. We used alpha error margin of 5% and confidence interval of 95%. Results: We enrolled 50 cases of myomectomy consisted of 33 (66.0%) files for AM and 17 (34.0%) files for LM. The clinical presentation of fibroid was similar in both groups. The main operation time (H) was (1.27 ± 0.13) for laparoscopy which is much less than (2.05 ± 0.07) for laparotomy group (p = 0.006). In AM group we had 04 post-operatory complications against zero complications in LM group but the difference was not statistically significant (p = 0.387). In the second look laparoscopy, the types of adhesions were not statistically significant (p = 0.471). Conclusion: Laparoscopic offers advantages compared to abdominal myomectomy.

关键词： Laparoscopic Abdominal myomectomy Surgical and Post-Operative Outcomes

Enterovesical Fistula Complicating myomectomy: A Case Report

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Open Journal of Urology 2017年第4期7卷 75-78页

作者： K. C. Ekwedigwe I. Sunday-Adeoye S. Lengman M. E. Isikhuemen A. B. C. Daniyan E. N. Yakubu M. O. Eliboh I. E. A. Uguru National Obstetric Fistula Centre Abakaliki Nigeria

Background: Enterovesical fistula is an abnormal communication between the bladder and the gastrointestinal tract. It is an uncommon type of genital fistula, occasionally complicating pelvic surgeries. However, it is the most common type of fistula associated with diverticular disease of the colon. Other causes include cancer, trauma and iatrogenic injuries. Pneumaturia and fecaluria usually implies enterovesical fistula. Enterovesical fistula complicating myomectomy is an uncommon finding. Our aim is to report a case of enterovesical fistula following myomectomy. Case presentation: She is a 33-year-old nullipara who presented at the National Obstetric Fistula Centre, Abakaliki, Ebonyi State, South-Eastern Nigeria with a history of fecaluria, pneumaturia and haematochezia which started after myomectomy. Feculent fluid was obtained on urethral catheterization. Cystography was suggestive of enterovesical fistula. Conclusion: Enterovesical fistula is a possible complication of myomectomy. A high index of suspicion for this rare but potentially devastating condition is important for early diagnosis and appropriate management.

关键词： Enterovesical Fistula myomectomy Uterine Fibroid

Pseudoaneurysm after abdominal myomectomy: A rare but catastrophic complication

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Open Journal of Obstetrics and Gynecology 2013年第1期3卷 123-125页

作者： May-Tal Sauerbrun-Cutler Jason Kanos Adie Friedman Sarah Bernstein Department of Interventional Radiology St. Luke’s Roosevelt Hospital Center New York USA Department of Obstetrics and Gynecology St. Luke’s Roosevelt Hospital Center New York USA Department of Obstetrics Gynecology & Reproductive Sciences University of Pittsburgh Pittsburgh USA

Background: Uterine artery pseudoaneurysm is a rare diagnosis made postoperatively after pelvic surgery. The exact etiology is unknown however it is speculated to occur when an artery is lacerated and the perivascular tissue maintains persistent blood flow with the parent vessel. It can present with severe hemorrhage two to four weeks after an uncomplicated post operative course. Case: A 45 year old presented with vaginal hemorrhage and hypotension two weeks after abdominal myomectomy. Transvaginal ultrasound with doppler diagnosed pseudoaneurysm of the uterine artery. The patient was successfully treated with endovascular embolization utilizing micro coils. Conclusion: Transvaginal ultrasound is a useful technique in diagnosing pseudoaneurysms. Endovascular embolization is a minimally invasive, safe and effective way to treat this rare complication in institutions that have access to interventional radiology procedures.

关键词： myomectomy Pseudoaneurysm Ultrasound

Epidemiological-Clinical Aspects of Uterine Leiomyoma at the Reference Health Center of Commune VI of the Bamako District

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Open Journal of Obstetrics and Gynecology 2024年第5期14卷 674-681页

作者： Alou Samaké Lasseny Diarra Mamadou Keita Dramane Haidara Mamadou Haidara Coulibaly Soumana Mamadou Diallo Moussa Konaté Mariam Maiga MS Ag Med Elméhdi Elansari Kassogue Djibril Dao Seydou Zana Samake Hawa Konate Karim Dembele Bertin Coulibaly Moussa Mariko Seydou Colette Dohino Reference Health Center of Commune VI of the Bamako District Bamako Mali Bamako Dermatology Hospital (HDB) Bamako Mali Kalaban Coro Reference Health Center Bamako Mali Hangadoumbo Moulaye Touré Hospital in Gao Gao Mali Timbuktu Hospital Tomboctou Mali Reference Health Center of Commune II of the Bamako District Bamako Mali Reference Health Center in Commune V of the Bamako District Bamako Mali National Institute for Training in Health Sciences Bamako Mali Mali Hospital Bamako Mali

Introduction: Uterine fibroid is a mixed mesenchymal tumor, developing from smooth muscle cells of the myometrium, separated by connective tissue. The majority of fibroids are asymptomatic and do not require any intervention or other exploratory measures. However, in some cases fibroids are symptomatic, their treatment should aim to improve symptoms and quality of life. Objectives: Describe the epidemiological-clinical aspects of uterine fibroids in the gynecology and obstetrics department of the reference health center of commune VI of the Bamako district. Methodology: This was a retrospective descriptive study carried out over a period of one year. It concerns all patients seen in consultation in the gynecology and obstetrics department of the reference health center of commune VI. Results: during the study period, the uterine fibroid frequency was 1.80%. During this same period, fibroids represented 5.59% of gyneco-obstetric pathologies operated on in the department. The 30 - 45 year old age group was the most represented with a frequency of 75.63%. The average age was 36.87 years ± 6.2 years with extremes of 25 and 63 years. Married women were the most represented 97.48%. The vast majority of our patients 95.8% were not postmenopausal. The multigravidas were the most represented, i.e. 37.50% with a large part of the pauciparous 41.29%. In our patients, 96.64% had a clinical symptom on their fibroid with the main reason for consultation being the sensation of a pelvic mass in 97.48%. We recorded three cases of infertility as associated factors. Ultrasound was performed in all patients. The location of the myxomatous nuclei was subserosal in the majority in 42.86% and with multiple nodules in 84.85% of cases. The main indication for myomectomy was the failure of medical treatment in 86.49% of cases. Surgical treatment was mainly a myomectomy 93.30%, a hysterectomy was indicated in 6.70%. No cases of death were recorded. Conclusion: Uterine fibroid is a gynecologic

关键词： Myomas Surgery myomectomy