Indications of laparoscopic myomectomy and efficacy of preoperative GnRHa therapy
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概要
- 論文の詳細を見る
Purpose: The purpose of this study was to evaluate indications of laparoscopic myomectomy (LM) and the efficacy of preoperative GnRHa therapy. Methods: Study subjects were 161 patients who underwent LM between 1995 and 2007 at our hospital. Based on surgical performance, indications of LM were discussed in terms of the size and number of myomas. The efficacy of preoperative GnRHa therapy was evaluated by comparing the volume of myomas on MRI images and surgical performances. The recurrence rate after LM was evaluated by comparing the number of myomas confirmed on preoperative MRI and that actually enucleated. Statistical analysis was performed by ANOVA, Student's t-test, χ-square test and the Kaplan-Meier method. For all tests, p＜0.05 was considered significant. Results: The group with myomas ≧10cm showed significant increases in blood loss, operative time, and the rate of conversion to laparotomy compared with groups with smaller myomas. However, the number of myomas was not a factor that affected surgical performance. The myoma volume was reduced as a result of 43％ by preoperative GnRHa therapy without compromising surgical performance. No significant difference was observed on GnRHa therapy in the 4-year cumulative recurrence rate. The recurrence rate was significantly higher in the group in which there was a possiblity that some of myomas were missed and left.Discussion: The indications of LM were considered for myomas ＜10cm but not limited by the number of myomas. The postoperative recurrence rate will decrease if surgery is completed on ensuring no myoma has been overlooked by precisely identifying the preoperative myoma status on MRI. Preoperative GnRHa therapy was considered to be a factor not compromising the surgical performance and recurrence rate, but was effective as a pretreatment for LM to expand the indications.
- The Kinki University Medical Associationの論文
著者
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Kotani Yasushi
Dep. Of Obstetrics And Gynecology Kinki Univ. School Of Medicine
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Shimaoka Masao
Kinki Univ. Fac. Medicine Osaka Jpn
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