(4)無茎性粘膜下子宮筋腫に対する子宮鏡下手術の工夫 : 一期的摘出法標準化の試み(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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Hysteroscopic myomectomy is an excellent surgery for submucous myoma patients suffering from menorrhagia and/or infertility. A sessile myoma, however, is technically difficult to remove completely at a time by standard hysteroscopic resection. I present herein a safe strategy for a single stage resection of an unpediculated myoma. First step is a resection of the intrauterine dome of the myoma. I performed scraping the dome with an electrode with a safeguard attached at its far end and/or vaporizing the node to a flat surface until same level around intrauterine cavity. Next procedure is an intraoperative injection of prostaglandin F2 alpha to the uterine body or cervix. The remnant node was squeezed by uterine contractions induced by this agent. Final step is the resection or vaporization of the newly raised myoma dome in only intrauterine cavity, and/or mechanical separation of the node from surrounding normal tissue with the roller-typed electrodes without electrosurgery under ultrasound monitoring. In this strategy main manipulations of the electrical surgery perform only in intrauterine space, and consequently the intraoperative uterine perforation can be avoided. Twenty-eight patients, ranged in age from 20 to 47, were operated in this strategy. Sixteen patients (57.1%) removed completely their submucous myomas at one time. The logistic regression analysis showed the thickness of the outer myometrial layer was significantly associated with a reduction in the risk of imcomplete surgery, and the myoma size and the degree of the intramural extension was also significantly associated with an increase in the risk. In conclusion, the combination of techniques-the use of appropriate electrodes, the extruding the remnant myoma by the oxytocic agent-induced uterine contractions, and uncritical manipulations-will allow safe and certain hysteroresectoscopy of a sessile submucous myoma. Even if the case with a myoma node arising from the uterine fundus, the successful single-step resection may be performed completely. The thickness of the outer myometrial layer of the myoma node, the myoma size, and the degree of the intramural extension are important predictive factors of the outcome of our one-step hysteroscopic myomectomy.
社団法人日本産科婦人科学会の論文
2006-12-01

(4)無茎性粘膜下子宮筋腫に対する子宮鏡下手術の工夫 : 一期的摘出法標準化の試み(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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