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Objective To assess the effects on volume of uterine and the dominant fibroid by a re-new radiofrequency ablation ( RFA ) on uterine myomas and disemboweling them from uterine after RFA . Methods Three hundred and eight -three patients were treated by RFA and followed up at 1, 3, 6 and 12 months,165 of them by usual RFA , 163 by improved RFA.To them which myomas diameters were >5cm, 55 cases were added by disemboweling the myomas out of the body after one month of improved RFA .But 66 were not disemboweled.The pre-and postoperative uterine and myoma volumes were measured by 3D ul-trasonography .Results The volume of uterine and the dominant fibroid were reduced in usual and im-proved RFA groups , especially in improved group ,but the difference was no significantly ( P >0.05 ) .In the groups of which myomas diameters were >5cm , the median reduction rates of uterine and myoma vol-ume was more significantly in disemboweling group than un -disemboweling one after 3 and 6 months ( P 0.05),and in disemboweling and un -disemboweling groups ( P >0.05).But the obvious effective rates have significant difference in disemboweling (81.82%)and un-dis-embowelin(41.94%)group ( P <0.01).Conclusion Disemboweling myomas from uterine after RFA can increase the clinical effects significantly .
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OBJECTIVE: The purpose of this study was to evaluate the efficacy and safety of transvaginal radiofrequency myolysis of uterine myomas. METHODS: 67 women who had undergone transvaginal radiofrequency myolysis of uterine myomas at Eulji university hospital between May 2005 and March 2006 were participated in this study. Pre-procedural transabdominal and transvaginal ultrasonographic evaluation was done for measurement of the size, numbers, location, and volume of the myomas. 1 month, 3 months, and 6 months after the procedure the numbers and size of the myomas were measured by the same examiner. And also improvement of menorrhagia, dysmenorrhea, abnormal vaginal bleeding, and any symptoms like urinary frequency and pelvic pain that were caused by compression of the myomas were observed on every visit. RESULTS: The average age of the patients were 42.2 years. The average number of myomas were 1.18, the average of the maximal diameter was 5.52 cm, and the average volume was 89.9 cm3. The average procedure time was 15.1 minutes, and the average procedure frequency was 1.4 times. 1 month, 3 moths, and 6 months after the procedure the average maximal diameter of the myomas were decreased by 14.2%, 22.8%, and 29.8% respectively and the average volume decreased by 34.9%, 52.5%, and 63.6% respectively. 8 women who had no early symptoms and who were postmenopaused were excluded and from the other 59 women, 45 women and 37 women had been confirmed of their symptoms after 3 months and 6 months of the procedure respectively. 86.7%, 82.8% of the group had improvement of dysmenorrhea, and 65.2%, 60% had improvement of menorrhagia after 3 months and 6 months of procedure respectively. The group which had both symptoms, 85% and 81.2% had improvement. There were post-procedural complications of lower abdominal pain in 7 women, vaginal bleeding in 1 woman and in 1 case the patient was transferred to the department of internal medicine due to post-procedural fever and abdominal discomfort. No other major complications were found. CONCLUSION: Transvaginal radiofrequency myolysis had benefits in conserving the uterus, and was less invasive and had great effect on the reduction of size of the myomas and improving the symptoms. So this method could be a effective alternative treatment for uterine myomas.
Subject(s)
Female , Humans , Abdominal Pain , Dysmenorrhea , Fever , Internal Medicine , Leiomyoma , Menorrhagia , Moths , Myoma , Pelvic Pain , Uterine Hemorrhage , UterusABSTRACT
Objective To evaluate the middle-term effect of laparoscopic uterine artery occlusion combined with ascendant myomectomy (LUAO-M) for multiple uterine myomas. Methods The uterine artery was isolated and occluded with Kleppinger bipolar forceps (Sabre 2400,ASPEN LABS USA) or PK forceps (Gyrus Medical Limited Inc UK) under a laparoscope. Then dissection was performed on the surface of pseudo capsule with Kleppinger unipolar needle (Sabre 2400,ASPEN LABS USA) or PK needle (Gyrus Medical Limited Inc UK),and the target myoma was stripped out of the tumor bed with the Separate-Scoop device. Afterwards,repair of the incision was carried out in one layer with interrupted single stitch by Absorbable VICRYL suture (Johnson VICRYL ETHICON USA). Results The mean operation time was (102?36) min and mean blood loss was (88.7?58.4) ml. The mean hospital stay after the operation was (7.9?0.2) d,and febrile morbidity was 5.1% (5/98). Complications included two cases of subcutaneous emphysema and one case of ileus;no other severe complications occurred. Of the patients,98 cases were followed-up for 21 to 52 months (mean,36.3 months),during the period they were visited by a mean of 3.6 times,which showed a correction rate of menstruation abnormality of 95.9% (4/98),rate of uterine volume reduction of 57.7%,and rate of recurrent myoma of 3.1% (3/98). Conclusion LUAO-M shows a good clinical outcome and middle-term effect for multiple uterine myomas.
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In the hormonal treatment of uterine myomas, which are estrogen dependent, GnRH agonist (GnRHa) therapy has become widespread. However, GnRHa therapy causes uncomfortable or harmful side effects such as climacteric symptoms. The aim of this study is to evaluate the effect of Kampo (herbal) medicine to diminish climacteric symptoms induced by the GnRHa. Twenty-six patients with symptomatic uterine myoma were recruited, and informed consent was obtained from all subjects. Leuprolide acetate depot 3.75mg (LA) as GnRHa was given with subcutaneous injection every four weeks for six months. After LA therapy was initiated, Toki-shakuyaku-san, Kami-shoyo-san, or Keishi-bukuryo-gan was given from the second month of treatment. Climacteric symptoms were evaluated with Simplified Menopausal Index, which was improved for Japanese women. In the present study, we found all three Kampo medicines were useful. In particular, Kami-shoyo-san was useful for climacteric symptoms induced by LA. Also, LA therapy combined with Keishi-bukuryo-gan had beneficial effects in uterine myomas. However, the precise mechanism by which results were achieved remains unclear. Therefore, further research may be necessary to evaluate the ability of Kampo medicines to diminish climacteric symptoms induced by GnRHa.
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Objective:To investigate the influences of laparoscopic surgery on Th1/Th2 balance in patients with uterine myomas.Methods:In a prospective study,the number of the Th subsets,Th1/Th2 ratio,the serum level of IL-18 and IL-10 in 20 patients submitted to laparoscopic operation and 20 patients undergoing conventional open operation were evaluated preoperatively as well as 2,24,48 h postoperatively.Results:The level of Th1 cell,IL-18,and the Th1/Th2 ratio decreased significantly (laparoscopic group: P