(3)腹腔鏡下筋腫核出術における安全な手術手技の確立とその限界(講演要旨,<特集>第58回学術講演会シンポジウム-4「安全性の向上をめざした婦人科良性腫瘍に対する内視鏡手術」)

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Laparoscopic myomectomy(LM), which is one of the most difficult surgical techniques for gynecologic benign diseases, was examined for the limitations of surgical indications, middle- and long-term prognosis, and technical succession. 1. Limitations of LM: 629 patients subjected to LM who were operated on by the same surgeon(HT) from 1996 to 2005 were divided into four groups (good postoperative course group, prolonged operation group, bleeding group, and mixed group) using the cut off values of duration of the operation and bleeding (mean ± 1.5SD). The number of myomas removed was significantly larger in the prolonged operation group (9.3 ± 6.5, p<0.01). The diameter of myomas removed tended to be significantly larger in the bleeding and mixed (prolonged operation and large bleeding volume) groups (10.6 ± 2.6 cm and 9.8 ± 2.7 cm, respectively, p<0.01). 2. Middle- and long-term prognosis of LM: Second-look laparoscopy(SLL) was performed in 231 patients six months after LM. Post-operative adhesions to the uterine wound were found in 94 patients (40.7%) and de-novo adhesions to the appendages in 15 (6.5%). A multivariate analysis of the results revealed that the risk factors of postoperative adhesions included the maximum myoma diameter and the number of myomas removed, while the risk reducing factors included the use of a fibrin adhesive spray and a hyaluronic acid sheet as anti-adhesion agents. Of 261 patients who were infertile after LM, 115 (44.1%) got pregnant and 85 (73.9%) were delivered. Transvaginal delivery was attempted in 51 cases and was successful in 42 (82.4%). 3. Technical succession: The learning curves of four surgeons other than HT were compared to evaluate the educational system intended to train surgeons. All the surgeons came to handle more difficult cases as their experience of LM increased and their surgical results remained at a good level, which suggests an improvement of their surgical skills.
社団法人日本産科婦人科学会の論文
2006-12-01

(3)腹腔鏡下筋腫核出術における安全な手術手技の確立とその限界(講演要旨,<特集>第58回学術講演会シンポジウム-4「安全性の向上をめざした婦人科良性腫瘍に対する内視鏡手術」)

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