UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

子宫平滑肌瘤(子宫肌瘤)的腹腔镜下肌瘤切除术及其他腹腔镜治疗

Author
William H Parker, MD
Section Editor
Tommaso Falcone, MD, FRCSC, FACOG
Deputy Editor
Sandy J Falk, MD, FACOG
Translators
冯炜炜, 主任医师

引言

腹腔镜技术为多种妇科手术操作提供了微创的选择。肌瘤切除术指切除子宫平滑肌瘤(子宫肌瘤)，对某些女性可经腹腔镜完成。包括子宫动脉阻断术和子宫肌瘤消融术在内的其他腹腔镜操作也被研发用于平滑肌瘤的治疗，但这些操作并不常用。

子宫平滑肌瘤是女性中最常见的盆腔肿瘤，终生风险约为70%-80%[1-3]。平滑肌瘤的治疗方法多种多样，既包括药物治疗也包括手术治疗。治疗方式的选择取决于多种因素，包括肌瘤特征、患者和手术专业技能。

子宫平滑肌瘤的腹腔镜下肌瘤切除术及其他腹腔镜操作将总结在此。经腹、经宫腔镜和经阴道肌瘤切除术，以及平滑肌瘤的其他治疗方法将单独讨论。 (参见“经腹子宫肌瘤切除术”和“宫腔镜子宫肌瘤切除术”和“子宫肌瘤(纤维瘤)脱垂”和“子宫平滑肌瘤(纤维瘤)的治疗概述”)

患者的选择

腹腔镜下肌瘤切除术主要用于切除肌壁间或浆膜下的平滑肌瘤(图 1)。宫腔内肌瘤(黏膜下肌瘤和部分突入子宫内膜腔的肌壁间肌瘤)(图 2)难以通过腹腔镜下肌瘤切除术来切除。此外，当仅切除宫腔内肌瘤时，宫腔镜肌瘤切除术是首选的治疗方式，因为它具有恢复时间短和围手术期并发症少的优势。对于同时存在黏膜下肌瘤和肌壁间/浆膜下肌瘤的女性患者，可能适合腹腔镜肌瘤切除术联合宫腔镜肌瘤切除术。 (参见“宫腔镜子宫肌瘤切除术”，关于‘患者选择’一节)

具有以下特征的女性适合进行腹腔镜下肌瘤切除术：

                                             

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: 2017-06 . | This topic last updated: 2016-01-26.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Baird DD, Dunson DB, Hill MC, et al. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol 2003; 188:100.
  2. Buttram VC Jr, Reiter RC. Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril 1981; 36:433.
  3. Serden SP, Brooks PG. Treatment of abnormal uterine bleeding with the gynecologic resectoscope. J Reprod Med 1991; 36:697.
  4. Parker WH, Rodi IA. Patient selection for laparoscopic myomectomy. J Am Assoc Gynecol Laparosc 1994; 2:23.
  5. Sizzi O, Rossetti A, Malzoni M, et al. Italian multicenter study on complications of laparoscopic myomectomy. J Minim Invasive Gynecol 2007; 14:453.
  6. Jin C, Hu Y, Chen XC, et al. Laparoscopic versus open myomectomy--a meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol 2009; 145:14.
  7. Bulletti C, Polli V, Negrini V, et al. Adhesion formation after laparoscopic myomectomy. J Am Assoc Gynecol Laparosc 1996; 3:533.
  8. Advincula AP, Xu X, Goudeau S 4th, Ransom SB. Robot-assisted laparoscopic myomectomy versus abdominal myomectomy: a comparison of short-term surgical outcomes and immediate costs. J Minim Invasive Gynecol 2007; 14:698.
  9. Barakat EE, Bedaiwy MA, Zimberg S, et al. Robotic-assisted, laparoscopic, and abdominal myomectomy: a comparison of surgical outcomes. Obstet Gynecol 2011; 117:256.
  10. Ascher-Walsh CJ, Capes TL. Robot-assisted laparoscopic myomectomy is an improvement over laparotomy in women with a limited number of myomas. J Minim Invasive Gynecol 2010; 17:306.
  11. Advincula AP, Song A, Burke W, Reynolds RK. Preliminary experience with robot-assisted laparoscopic myomectomy. J Am Assoc Gynecol Laparosc 2004; 11:511.
  12. Nezhat C, Lavie O, Hsu S, et al. Robotic-assisted laparoscopic myomectomy compared with standard laparoscopic myomectomy--a retrospective matched control study. Fertil Steril 2009; 91:556.
  13. Hurst BS, Matthews ML, Marshburn PB. Laparoscopic myomectomy for symptomatic uterine myomas. Fertil Steril 2005; 83:1.
  14. Bedient CE, Magrina JF, Noble BN, Kho RM. Comparison of robotic and laparoscopic myomectomy. Am J Obstet Gynecol 2009; 201:566.e1.
  15. George A, Eisenstein D, Wegienka G. Analysis of the impact of body mass index on the surgical outcomes after robot-assisted laparoscopic myomectomy. J Minim Invasive Gynecol 2009; 16:730.
  16. Greenberg JA, Einarsson JI. The use of bidirectional barbed suture in laparoscopic myomectomy and total laparoscopic hysterectomy. J Minim Invasive Gynecol 2008; 15:621.
  17. Lee JH, Choi JS, Jeon SW, et al. Single-port laparoscopic myomectomy using transumbilical GelPort access. Eur J Obstet Gynecol Reprod Biol 2010; 153:81.
  18. Kim YW, Park BJ, Ro DY, Kim TE. Single-port laparoscopic myomectomy using a new single-port transumbilical morcellation system: initial clinical study. J Minim Invasive Gynecol 2010; 17:587.
  19. Yoshiki N, Okawa T, Kubota T. Single-incision laparoscopic myomectomy with intracorporeal suturing. Fertil Steril 2011; 95:2426.
  20. Einarsson JI. Single-incision laparoscopic myomectomy. J Minim Invasive Gynecol 2010; 17:371.
  21. Dueholm M, Lundorf E, Hansen ES, et al. Accuracy of magnetic resonance imaging and transvaginal ultrasonography in the diagnosis, mapping, and measurement of uterine myomas. Am J Obstet Gynecol 2002; 186:409.
  22. ACOG Committee on Practice Bulletins--Gynecology. ACOG practice bulletin No. 104: antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol 2009; 113:1180. Reaffirmed 2016.
  23. Kocak I, Ustün C, Emre B, Uzel A. Antibiotics prophylaxis in laparoscopy. Ceska Gynekol 2005; 70:269.
  24. Vokach-Brodsky, L. Anesthesia. In: Nezhat's Operative Gynecologic Laparoscopy and Hysteroscopy, Nezhat, C, Nezhat, FR, Nezhat, C, eds. (Eds), Cambridge University Press, New York 2008. p.37.
  25. Agarwala N, Liu CY. Safe entry techniques during laparoscopy: left upper quadrant entry using the ninth intercostal space--a review of 918 procedures. J Minim Invasive Gynecol 2005; 12:55.
  26. Koh C, Janik G. Laparoscopic myomectomy: the current status. Curr Opin Obstet Gynecol 2003; 15:295.
  27. Litta P, Fantinato S, Calonaci F, et al. A randomized controlled study comparing harmonic versus electrosurgery in laparoscopic myomectomy. Fertil Steril 2010; 94:1882.
  28. Zhao F, Jiao Y, Guo Z, et al. Evaluation of loop ligation of larger myoma pseudocapsule combined with vasopressin on laparoscopic myomectomy. Fertil Steril 2011; 95:762.
  29. Dubuisson JB, Fauconnier A, Deffarges JV, et al. Pregnancy outcome and deliveries following laparoscopic myomectomy. Hum Reprod 2000; 15:869.
  30. Nezhat C. The "cons" of laparoscopic myomectomy in women who may reproduce in the future. Int J Fertil Menopausal Stud 1996; 41:280.
  31. Hockstein S. Spontaneous uterine rupture in the early third trimester after laparoscopically assisted myomectomy. A case report. J Reprod Med 2000; 45:139.
  32. Paul GP, Naik SA, Madhu KN, Thomas T. Complications of laparoscopic myomectomy: A single surgeon's series of 1001 cases. Aust N Z J Obstet Gynaecol 2010; 50:385.
  33. Sinha R, Hegde A, Mahajan C, et al. Laparoscopic myomectomy: do size, number, and location of the myomas form limiting factors for laparoscopic myomectomy? J Minim Invasive Gynecol 2008; 15:292.
  34. Landi S, Zaccoletti R, Ferrari L, Minelli L. Laparoscopic myomectomy: technique, complications, and ultrasound scan evaluations. J Am Assoc Gynecol Laparosc 2001; 8:231.
  35. Malzoni M, Rotond M, Perone C, et al. Fertility after laparoscopic myomectomy of large uterine myomas: operative technique and preliminary results. Eur J Gynaecol Oncol 2003; 24:79.
  36. Andrei B, Crovini G, Rosi A. Uterine myomas: pelviscopic treatment. Clin Exp Obstet Gynecol 1999; 26:44.
  37. Dubuisson JB, Fauconnier A, Chapron C, et al. Second look after laparoscopic myomectomy. Hum Reprod 1998; 13:2102.
  38. Mais V, Ajossa S, Piras B, et al. Prevention of de-novo adhesion formation after laparoscopic myomectomy: a randomized trial to evaluate the effectiveness of an oxidized regenerated cellulose absorbable barrier. Hum Reprod 1995; 10:3133.
  39. Hasson HM, Rotman C, Rana N, et al. Laparoscopic myomectomy. Obstet Gynecol 1992; 80:884.
  40. Broder MS, Goodwin S, Chen G, et al. Comparison of long-term outcomes of myomectomy and uterine artery embolization. Obstet Gynecol 2002; 100:864.
  41. Yoo EH, Lee PI, Huh CY, et al. Predictors of leiomyoma recurrence after laparoscopic myomectomy. J Minim Invasive Gynecol 2007; 14:690.
  42. Nezhat FR, Roemisch M, Nezhat CH, et al. Recurrence rate after laparoscopic myomectomy. J Am Assoc Gynecol Laparosc 1998; 5:237.
  43. Minig L, Trimble EL, Sarsotti C, et al. Building the evidence base for postoperative and postpartum advice. Obstet Gynecol 2009; 114:892.
  44. Tsuji S, Takahashi K, Imaoka I, et al. MRI evaluation of the uterine structure after myomectomy. Gynecol Obstet Invest 2006; 61:106.
  45. Wallach EE, Vlahos NF. Uterine myomas: an overview of development, clinical features, and management. Obstet Gynecol 2004; 104:393.
  46. Parker WH, Einarsson J, Istre O, Dubuisson JB. Risk factors for uterine rupture after laparoscopic myomectomy. J Minim Invasive Gynecol 2010; 17:551.
  47. Werner S, Grose R. Regulation of wound healing by growth factors and cytokines. Physiol Rev 2003; 83:835.
  48. Hald K, Langebrekke A, Kløw NE, et al. Laparoscopic occlusion of uterine vessels for the treatment of symptomatic fibroids: Initial experience and comparison to uterine artery embolization. Am J Obstet Gynecol 2004; 190:37.
  49. Yen YK, Liu WM, Yuan CC, Ng HT. Laparoscopic bipolar coagulation of uterine vessels to treat symptomatic myomas in women with elevated Ca 125. J Am Assoc Gynecol Laparosc 2001; 8:241.
  50. Lichtinger M, Hallson L, Calvo P, Adeboyejo G. Laparoscopic uterine artery occlusion for symptomatic leiomyomas. J Am Assoc Gynecol Laparosc 2002; 9:191.
  51. Hald K, Kløw NE, Qvigstad E, Istre O. Laparoscopic occlusion compared with embolization of uterine vessels: a randomized controlled trial. Obstet Gynecol 2007; 109:20.
  52. Wang PH, Liu WM, Fuh JL, et al. Laparoscopic uterine vessel occlusion in the treatment of women with symptomatic uterine myomas with and without adding laparoscopic myomectomy: 4-year results. J Minim Invasive Gynecol 2008; 15:712.
  53. Hald K, Noreng HJ, Istre O, Kløw NE. Uterine artery embolization versus laparoscopic occlusion of uterine arteries for leiomyomas: long-term results of a randomized comparative trial. J Vasc Interv Radiol 2009; 20:1303.
  54. Chang WC, Chou LY, Chang DY, et al. Simultaneous laparoscopic uterine artery ligation and laparoscopic myomectomy for symptomatic uterine myomas with and without in situ morcellation. Hum Reprod 2011; 26:1735.
  55. Goldfarb HA. Laparoscopic coagulation of myoma (myolysis). Obstet Gynecol Clin North Am 1995; 22:807.
  56. Zupi E, Piredda A, Marconi D, et al. Directed laparoscopic cryomyolysis: a possible alternative to myomectomy and/or hysterectomy for symptomatic leiomyomas. Am J Obstet Gynecol 2004; 190:639.
  57. Visvanathan D, Connell R, Hall-Craggs MA, et al. Interstitial laser photocoagulation for uterine myomas. Am J Obstet Gynecol 2002; 187:382.
  58. Nisolle M, Smets M, Malvaux V, et al. Laparoscopic myolysis with the Nd:YAG laser. J Gynecol Surg 1993; 9:95.
  59. Zupi E, Marconi D, Sbracia M, et al. Directed laparoscopic cryomyolysis for symptomatic leiomyomata: one-year follow up. J Minim Invasive Gynecol 2005; 12:343.
  60. Arcangeli S, Pasquarette MM. Gravid uterine rupture after myolysis. Obstet Gynecol 1997; 89:857.
  61. Lefebvre G, Vilos G, Allaire C, et al. The management of uterine leiomyomas. J Obstet Gynaecol Can 2003; 25:396.
  62. Vilos GA, Daly LJ, Tse BM. Pregnancy outcome after laparoscopic electromyolysis. J Am Assoc Gynecol Laparosc 1998; 5:289.
  63. Donnez J, Squifflet J, Polet R, Nisolle M. Laparoscopic myolysis. Hum Reprod Update 2000; 6:609.
  64. Goldfarb HA. Combining myoma coagulation with endometrial ablation/resection reduces subsequent surgery rates. JSLS 1999; 3:253.