Clinical Review on 304 Cases of Hysteroscopic Myomectomy / 대한산부인과학회지

OBJECTIVE: The aim of this study is to extend the indications of hysteroscopic myomectomy. METHODS: Total 304 women who had undergone hysteroscopic myomectomy between February 2001 and March 2005, were selected. Clinical characteristics, laboratory data and postoperative results were analyzed. RESULTS: Mean size of myoma is 3.5 cm, mean op. time is 47 minutes, mean deficit of distension media is 193 cc, types of distension media is URIONE(R) and normal saline, average duration of hospitalization is 4.9 days, average changes of Hb. is 1.5 g/dL, complications of op. were happended in 14 cases, that is uterine perforation (n=8), hyponatremia (n=2), pulmonary edema (n=2), delayed bleeding (n=2). CONCLUSION: The indications of hysteroscopic myomectomy can be extended. In case that patient want to preserve the uterus, deep myometrial embedded or pure intramural myoma might be resected hysteroscopically by single- or multi-step procedure. Hysteroscopic myomectomy performed at observational period may be alternative to hysterectomy in selected cases. In case of recurrence, repeat procedure may reduce the chance of hysterectomy. Intraoperative ultrasonographic guidance is an important procedure in hysteroscopic myomectomy. It lower the complications and morbidity rate.

The Effect on IVF-ET Outcomes of Intramural Myomas / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to assess the effect of intramural uterine myoma in patients with a normal endometrial cavity on IVF-ET cycle outcome. This study was also investigated to find out whether medical supression or myomectomy needs to precede to IVF-ET. METHODS: The subjects were 300 infertile patients who got IVF-ET from January 1999 to December 2002 at the Department of Obstetrics and Gynecology in Kyungpook National University Hospital, and they were divided into myoma group of 97 patients and non-myoma group of 203 ones. This study group did not include patients found to have large myoma (>or= 7 cm), or myoma distorting the uterine cavity. RESULTS: Compared with the results of IVF-ET according to the presence of intramural uterine myoma, pregnancy rate and implantation rate between two groups had no statistically significant differences (p>0.05). Further comparisons within the myoma group showed no difference in pregnancy rate by number of myomas or site of myomas (p>0.05). CONCLUSION: Intramural uterine myoma not distorting the uterine cavity is considered to have no effect on the outcome of IVF-ET and no difference in the pregnancy rate according to the number of myomas or site of myomas. Therefore, these findings suggest that medical treatments or myomectomy before IVF-ET is not necessary to those infertile patients with intramural uterine myomas not distorting the uterine cavity.

Comparison between Laparoscopic and Open Myomectomies for Intramural Myoma / 中国微创外科杂志

Objective To evaluate the value of laparoscopy in the treatment of intramural myoma.Methods Totally 120 cases of intramural myoma were randomly divided into laparoscopy(n=52)and open groups(n=68).Clinical data,including operation time,intraoperative blood loss,rates of postoperative pyrexia and postoperative complications,length of hospital stay and follow-up,were compared between the two groups.Results Compared to the open group,the laparoscopy group had significantly longer operation time (106.3?54.9)min vs(66.5?7.3)min,t=5.918,P=0.000],less blood loss 10-300 ml(median,50 ml)vs 20-200 ml(median,50 ml),Z=-1.998,P=0.046],lower rate of postoperative pyrexia 7.7%(4/52)vs 30.9%(21/68),?2=9.608,P=0.002],similar rate of postoperative complications 3.8%(2/52)vs 8.3%(3/36),?2=0.000,P=1.000],shorter hospital stay (7.5?1.4)d vs(10.4?1.2)d,t=-12.201,P=0.000],and similar length of follow-up (9.7?2.3)months vs(9.6?1.8)months,t=0.267,P=0.790] and rate of normal menses 94.4%(17/18)vs 90.5%(19/21),?2=0.000,P=1.000].Conclusions Laparoscopy is as effective as open surgery for intramural myoma.While the laparoscopy leads to better postoperative recovery than the open surgery.