超小型腹腔手術可能對於子宮肌瘤有效


  【24drs.com】January 11, 2010 — 根據線上發表於2009年12月25日美國婦產科期刊(American Journal of Obstetrics & Gynecology)的世代研究結果,相較於傳統的腹腔手術(laparotomy,LT),超小型腹腔手術(ultraminilaparotomy,UMLT)以及腹腔鏡輔助UMLT,對於特定的子宮肌瘤病患的處置可以提供一些優點。
  
  台灣國立陽明大學醫學院的Kuo-Chang Wen醫師等人寫道,子宮肌瘤是子宮最常見的良性腫瘤,對於有症狀且希望保留生育能力的婦女,通常建議肌瘤切除術。隨著技術和器械的進步,腹腔鏡肌瘤切除術(laparoscopic myomectomy,LM)已經比較普遍,但它是比較複雜且技術上比較有挑戰性、需較長學習時間的手術。我們試圖比較採用腹腔手術 (LT)以及其他兩個改版方式:UMLT以及腹腔鏡輔助UMLT (laparoscopically assisted [LA-UMLT]),對小於8公分且數量少於5個子宮肌瘤所進行的肌瘤切除術。
  
  比較各組(LT組有79名婦女(35.3%)、UMLT組有71名婦女(31.7%)、LA-UMLA組有74名婦女(33.0%))的手術參數、立即的術後恢復、治療結果。
  
  追蹤中位數52個月,這段期間,三組的復發率相似。相較於LT組,修改版方法在手術參數以及術後恢復方面有較佳的結果(所有 P < .05)。
  
  研究作者們寫道,UMLT和[LA-]UMLT在子宮肌瘤的處置上可以成功取代LT。
  
  研究限制包括,缺乏隨機化,導致三組之間沒有良好配對;LA-UMLT 組的病患比其他兩組年長;根據病患偏好選擇手術方式;取樣偏差。此外,由許多研究者來完成這些手術,此次研究的這三組的平均住院天數,比之前的系列研究還要長。
  
  研究作者們結論表示,修改版的UMLT和LA-UMLT都是安全的微創方式,可以取代LT而成功處置子宮肌瘤,它們的好處是術後迅速恢復。
  
  UMLT在處置子宮肌瘤上更可行,因為它是一個容易進行的技術,對於位於側邊到後方的子宮肌瘤,可以選用 [LA-]UMLT。
  
  台北榮民總醫院以及台灣台北國家科學委員會支持本研究。
  
  Am J Obstet Gynecol. 線上發表於2009年12月25日。

Ultraminilaparotomy May Be Effective for Uterine Fibroids

By Laurie Barclay, MD
Medscape Medical News

January 11, 2010 — Compared with traditional laparotomy, ultraminilaparotomy (UMLT) and laparoscopically assisted UMLT may offer some advantages in the management of selected patients with uterine fibroids, according to the results of a cohort study reported online first in the December 25, 2009, issue of the American Journal of Obstetrics & Gynecology.

"Uterine fibroids are the most common benign tumors of the uterus, and myomectomy is often advisable for symptomatic women who wish to preserve their childbearing capabilities," write Kuo-Chang Wen, MD, from the National Yang-Ming University School of Medicine in Taiwan, and colleagues. "With the advances being made in techniques and instruments, the laparoscopic myomectomy (LM) has become popular, although it is a more complicated and technically challenging procedure with a long learning curve.... We sought to compare myomectomy performed by laparotomy (LT), and 2 other modified approaches: [UMLT] and laparoscopically assisted [LA-]UMLT for uterine fibroids with a size <8 cm and the number <5."

Surgical parameters, immediate postoperative recovery, and therapeutic outcomes were compared among 79 women in the LT group (35.3%), 71 women in the UMLT group (31.7%), and 74 women in the LA-UMLT group (33.0%).

During a median follow-up of 52 months, recurrence rates were similar in the 3 groups. Compared with LT, the modified approaches had better outcomes in terms of surgical parameters and in postoperative recovery (all P < .05).

"UMLT and [LA-]UMLT can be used successfully in place of LT in the management of uterine fibroids," the study authors write.

Limitations of this study include lack of randomization, resulting in the 3 groups not being well matched; older patients in the LA-UMLT group than in the other 2 groups; choice of procedure based on patient preference; and selection bias. In addition, completion of the operation was finished by many investigators, and the average hospital stay was relatively longer in the 3 groups in this study than in previous series.

"The modified approaches, UMLT and LA-UMLT, are both safe, minimal-access options in place of LT in the successful management of uterine fibroids, since they have the advantage of rapid postoperative recovery," the study authors conclude. "UMLT might be more feasible in the management of uterine fibroids, since it is an easy-to-perform technique. For uterine fibroids located laterally to posteriorly, [LA-]UMLT may be an alternative."

Taipei Veterans General Hospital and the National Science Council, Taipei, Taiwan, supported this study.

Am J Obstet Gynecol. Published online December 25, 2009.

    
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