Objective To evaluate the therapeutic results of premyomectomy uterin e depleti on for the treatment of symptomatic fibroids, compared with myomectomy only. Des ignControlled, clinical study without randomization. Set...Objective To evaluate the therapeutic results of premyomectomy uterin e depleti on for the treatment of symptomatic fibroids, compared with myomectomy only. Des ignControlled, clinical study without randomization. Setting University affiliat ed tertiary referral center. Patient(s) Four hundred eighty-six women with symp tomatic fibroids warranting surgical treatment and who wished to retain their ut eri. Intervention( s) Ligation of the uterine arteries was performed by either a n abdominal or a laparoscopic approach before myomectomy. Main outcome measure(s )Operation time, intraoperative blood loss, postoperative improvement of symptom s, and recurrence rates of fibroids. Result(s) Of 342 women with pathology-conf irmed fibroids who were included in the study, 108 received myomectomy only (gro up Ⅰ), and 234 underwent the uterine depletion procedure followed bymyomectomy (group Ⅱ). Average blood loss was 250 ±132.5 mL for group Ⅰand 50 ±26.9 mL f or group Ⅱ. For patients with menorrhagia, 79 (84%) of 94 women in group Ⅰexp erienced complete resolution; all of the 194 women (100%) in group Ⅱhad resolu tion within 2 months of surgery. The recurrence rate of ultrasoundconfirmed fibr oids was 19.4%(21 of 108) in group Ⅰand 0%in group Ⅱ. Of the sexually active patients who were not using contraception,50%(49 of 98) in group Ⅰand 37.5%( 15 of 40) in group Ⅱhad a live birth. Conclusion(s) This study demonstrates the value of uterine depletion beforemyomectomy for the management of patients with symptomatic fibroids. The procedure reduced blood loss during the operation, re sulted in complete resolution of fibroid-related menorrhagia, and has the poten tial to prevent fibroid recurrence. Fertility capacity was apparently not compro mised by this new treatment approach.展开更多
文摘Objective To evaluate the therapeutic results of premyomectomy uterin e depleti on for the treatment of symptomatic fibroids, compared with myomectomy only. Des ignControlled, clinical study without randomization. Setting University affiliat ed tertiary referral center. Patient(s) Four hundred eighty-six women with symp tomatic fibroids warranting surgical treatment and who wished to retain their ut eri. Intervention( s) Ligation of the uterine arteries was performed by either a n abdominal or a laparoscopic approach before myomectomy. Main outcome measure(s )Operation time, intraoperative blood loss, postoperative improvement of symptom s, and recurrence rates of fibroids. Result(s) Of 342 women with pathology-conf irmed fibroids who were included in the study, 108 received myomectomy only (gro up Ⅰ), and 234 underwent the uterine depletion procedure followed bymyomectomy (group Ⅱ). Average blood loss was 250 ±132.5 mL for group Ⅰand 50 ±26.9 mL f or group Ⅱ. For patients with menorrhagia, 79 (84%) of 94 women in group Ⅰexp erienced complete resolution; all of the 194 women (100%) in group Ⅱhad resolu tion within 2 months of surgery. The recurrence rate of ultrasoundconfirmed fibr oids was 19.4%(21 of 108) in group Ⅰand 0%in group Ⅱ. Of the sexually active patients who were not using contraception,50%(49 of 98) in group Ⅰand 37.5%( 15 of 40) in group Ⅱhad a live birth. Conclusion(s) This study demonstrates the value of uterine depletion beforemyomectomy for the management of patients with symptomatic fibroids. The procedure reduced blood loss during the operation, re sulted in complete resolution of fibroid-related menorrhagia, and has the poten tial to prevent fibroid recurrence. Fertility capacity was apparently not compro mised by this new treatment approach.
