Author/Editor		Ribič-Pucelj, Martina; Tomaževič, Tomaž; Vogler, Andrej; Kobal, Borut
Title		Laparoskopska miomektomija - indikacije, tehnike in zapleti
Translated title		Laparoscopic myomectomy - indications, techniques and complications
Type		članek
Source		Endoskopska revija
Vol. and No.		Letnik 5, št. 12-13
Publication year		2000
Volume		str. 77-82
Language		slo
Abstract		Background. Retrospective analysis of indications, surgical techniques and complications of laparoscopic myomectomy. Patients and methods. Between October 1997 and July 2000, 326 women with with myomas exceeding 3 cm in diameter underwent laparoscopic myomectomy at the Department of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Slovenia. The mean patient age was 37,6 +- 6.2 year (range; 22 - 55 years) and the mean size of the leading myoma was 5.6 +- 2.1 cm (range; 3 - 15 cm). A 4-puncture technique was used and POR 8 was injected into the myometrium to reduce intraoperative bleeding. The incision to the myometrium above the myoma by means of a monopolar electric needle was done in 196 (64.0%) patients; ultracision was used in 116 (31.5%) patients. In 14 (4.5%) patients the base of the pedunculated myoma was ligated with an endo-loop and cut with scissors or an electric needle. The myometrium was reconstructed in one or two layers with single or reverse stitches in all patients, except in those in whom the pedunculated myoma was ligated and with an electric morcellator in 277 (85%). Results. The most frequent indications for laparoscopic myomectomy included reproductive problems (n = 86; 26.5%), growing myoma (n = 82; 25.0%), meno-metrorrhagia (n = 59; 18.2%) and pelvic pain (n = 50; 15.4%); 49 (14,9%) patients presented with polysymptomatic myomas. Myomas were solitary in 245 (75%) patients and mupltiple in 81 (25%). In 326 patients, a total of 438 myomas were removed. In 198 (60.8%) cases, the leading myoma was intramural, in 81 (24.8%) subserous, in 36 (11.1%) intraligamentary, in 7 (2.1%) cervical and 4 (1.2%) patients it was of a submucous type II and larger than 4 cm. In 95 (29.2%) patients additional endoscopic procedures were performed resection of submucous myoma and/or endometrium. (Abstract truncated at 2000 characters).
Summary		Izhodišča. Retrospektivna analiza indikacij, kirurških tehnik in zapletov laparoskopske miomektomije. Bolnice in metode. V obdobju med oktobrom 1997 in julijem 2000 smo na Ginekološki kliniki v Ljubljani naredili laparoskopsko miomektomijo pri 326 bolnicah z miomi, večjimi od 3 cm. Povprečna starost bolnic je bila 37,6 +- 6,2 leti (22 do 55), povprečna velikost vodilnega mioma pa 5,6 +- 2,1 cm (3 do 15 cm). Uporabili smo tehniko 4 vbodnih mest, za zmanjšanje medoperativne krvavitve smo uporabili POR 8. Monopolarno kirurško tehniko smo uporabili pri 1999 (61,0%) bolnicah, harmonični skalpel pa 116 (31,5%), ter endoskopsko zanko za ligiranje pecljatih miomov pri 11 (7,5%) bolnicah. Pri vseh bolnicah, razen pri 11, kjer smo bazo mioma ligirali, smo maternico zašili v 1 ali 2 plasteh. Miome smo odstranili iz trebušne votline skozi minimalno laparotomijo pri 49 (15,0%) bolnicah in z električnim morcelatorjem pri 277 (85%) bolnicah. Rezultati. Najpogostejša indikacija za laparoskopsko miomektomijo so bili reproduktivni problemi (n = 86; 26,5%), rastoči miom (n = 82; 25,0%), meno-metroragije (n = 59; 18,2%), bolečine (n = 50; 15,4%), pri 49 (14,9%) bolnicah pa so bili miomi polisimptomatski. Miomi so bili solitarni pri 245 (75,0%) in multipli pri 81 (25%) bolnicah. Skupaj smo pri 326 bolnicah odstranili 438 miomov. Pri 198 (60,8%) je bil dominantni miom intramuralen, pri 81 (24,8%) subserozen, pri 36 (11,1%) intraligamentaren, pri 7 (2,1%) cervikalen in pri 4 (1,2%) submukozen tipa II in večji of 4 cm. Pri 95 (29,2%) bolnicah smo naredili še dodatne endoskopske posege in sicer: adneksektomijo, cistektomijo, adheziolizo in fimbrioplastiko, sterilizacijo, histeroskopsko resekcijo submukoznega mioma in ablacijo endometrija. Laparoskopska miomektomija je bila uspešna pri 303 (90,0%) bolnicah, pri 23 (7,0%) je bila narejena konverzija v laparotomijo ali pa laparoskopska asistirana miomektomija. (Izvleček prekinjen pri 2000 znakih).
Descriptors		LEIOMYOMA SURGERY, LAPAROSCOPIC UTERINE NEOPLASMS TREATMENT OUTCOME