浅析利用手术难度评分预测腹腔镜下子宫肌瘤剔除术结局
|
摘要
目的:利用手术难度评分系统预测腹腔镜下子宫肌瘤剔除术(Laparoscopic myomectomy,LM)结局的可行性分析。方法:对新疆医科大学第一附属医院妇科2007.6-2008.12年收治的符合纳入标准的183例腹腔镜下子宫肌瘤剔除术的临床资料使用手术难度评分系统进行逐个评分,按评分结果与手术时间、术前术后血红蛋白(hemoglobin,HB)差值、术后肠功能恢复时间行相关分析,若相关,则依据评分结果将患者分为3组:第一组<5分;第二组≥5分,<8分;第三组≥8分,比较三组之间手术时间,术前术后HB差值及术后肠功能恢复时间有无差异。结果:根据统计显示,累计得分与手术时间、术前术后HB差值、术后肠功能恢复时间的r值分别0.661、0.521、0.307,均为正相关,前两者呈密切相关。而后者相关不密切。3组之间手术时间及术前术后HB差值均显示差异有统计学意义(P<0.05)。3组间两两比较结果显示,1、2组的手术时间和第3组之间差异有统计学意义(P均小于0.05)。1、2组的术前术后HB差值和第3组差异之间有统计学意义(P均小于0.05)。术后肠功能恢复时间1组与2组之间差异有统计学意义(P<0.05)。3组和1组、2组之间差异无统计学意义,P值分别为0.05,0.356。比较3组患者90min内完成手术的情况。差异有统计学意义(P<0. 05)。再次进行3组间两两比较,结果为: 1组和2组、第3组之间均有显著差异,P均<0.05。2、3组之间差异无统计学意义,P=0.0176(两两比较P<0. 017有统计学意义)。结论:手术难度评分系统对预测腹腔镜下子宫肌瘤剔除术的结局有一定的指导意义。手术难度评分分值集中分布在8分以下,随着手术难度评分的增加,手术时间延长,手术难度增加,术前术后HB差值也随之增加。手术难度≥8分时,手术较困难,手术时间明显延长,必要时可依据自身的手术技巧,选择手术方式。必要时果断地采取中转开腹手术,可降低手术难度,缩短手术时间,减少出血量,最大限度的减少创伤。
Objective: To make use of surgical difficulty prediction scoring system laparoscopic myomectomy (Laparoscopic myomectomy, LM) the outcome of the feasibility analysis. Methods: The First Affiliated Hospital of Xinjiang Medical University 2007.6-2008.12 gynecological hospital in line with the standard of the 183 cases of laparoscopic myomectomy surgery clinical data of the difficulty of scoring system used to carry out one by one score, according to score the results and the operative time, preoperative and postoperative hemoglobin (hemoglobin, HB) the margin, postoperative intestinal function recovery time line analysis, if relevant, the score based on the results of patients were divided into 3 groups: the first <5 scores; second group≥5 scores , <8 scores; The third group of≥8 scores, compared operative time among the three groups, preoperative and postoperative difference between HB and postoperative intestinal function recovery time whether the differences. Results: According to statistics, a total score and operative time, preoperative and postoperative difference between HB postoperative intestinal function recovery time of r = 0.661,0.521,0.307, are positively correlated, the former two were closely related. While the latter is not closely related. Operation time between group 3 and the difference between preoperative and postoperative HB show statistically significant difference (P <0.05). 22 among the 3 groups the results of the comparison showed that the operative time groups 1,2 and 3 groups were statistically significant differences (P <0.05). 1,2 Group HB difference before and after operation and the difference between the 3 groups was statistically significant (P <0.05). Postoperative intestinal function recovery time 1 group and the difference between the 2 groups was statistically significant (P <0.05). 3 group and one group, the difference between the 2 groups was not significant, P = 0.05,0.356. Group 3 patients with comparative 90min to complete the surgery. There were significant differences (P <0. 05). Re-22 3 group compared with the results as follows: Group 1 and Group 2, Group 3 were significant differences between, P all <0.05. 2,3 group was no significant difference between, P = 0.0176 (two Comparing the two P <0. 017 there is statistical significance). Conclusion: The surgical scoring system for predicting difficult laparoscopic myomectomy must have the outcome of the guide. Score the difficulty of the operation focused on the distribution of scores at 8 am the following, with the score of the increase in the difficulty of surgery, surgical time, increased difficulty of surgery, preoperative and postoperative margin also increased HB.≥8 timeshare operation difficult, more difficult surgery, prolonged operative time and, if necessary, surgery can be the basis of their skills, select the operation mode. If necessary, to take decisive conversion surgery, surgery to reduce the difficulty and shorten the operation time to reduce the amount of bleeding, to minimize trauma.
Objective: To make use of surgical difficulty prediction scoring system laparoscopic myomectomy (Laparoscopic myomectomy, LM) the outcome of the feasibility analysis. Methods: The First Affiliated Hospital of Xinjiang Medical University 2007.6-2008.12 gynecological hospital in line with the standard of the 183 cases of laparoscopic myomectomy surgery clinical data of the difficulty of scoring system used to carry out one by one score, according to score the results and the operative time, preoperative and postoperative hemoglobin (hemoglobin, HB) the margin, postoperative intestinal function recovery time line analysis, if relevant, the score based on the results of patients were divided into 3 groups: the first <5 scores; second group≥5 scores , <8 scores; The third group of≥8 scores, compared operative time among the three groups, preoperative and postoperative difference between HB and postoperative intestinal function recovery time whether the differences. Results: According to statistics, a total score and operative time, preoperative and postoperative difference between HB postoperative intestinal function recovery time of r = 0.661,0.521,0.307, are positively correlated, the former two were closely related. While the latter is not closely related. Operation time between group 3 and the difference between preoperative and postoperative HB show statistically significant difference (P <0.05). 22 among the 3 groups the results of the comparison showed that the operative time groups 1,2 and 3 groups were statistically significant differences (P <0.05). 1,2 Group HB difference before and after operation and the difference between the 3 groups was statistically significant (P <0.05). Postoperative intestinal function recovery time 1 group and the difference between the 2 groups was statistically significant (P <0.05). 3 group and one group, the difference between the 2 groups was not significant, P = 0.05,0.356. Group 3 patients with comparative 90min to complete the surgery. There were significant differences (P <0. 05). Re-22 3 group compared with the results as follows: Group 1 and Group 2, Group 3 were significant differences between, P all <0.05. 2,3 group was no significant difference between, P = 0.0176 (two Comparing the two P <0. 017 there is statistical significance). Conclusion: The surgical scoring system for predicting difficult laparoscopic myomectomy must have the outcome of the guide. Score the difficulty of the operation focused on the distribution of scores at 8 am the following, with the score of the increase in the difficulty of surgery, surgical time, increased difficulty of surgery, preoperative and postoperative margin also increased HB.≥8 timeshare operation difficult, more difficult surgery, prolonged operative time and, if necessary, surgery can be the basis of their skills, select the operation mode. If necessary, to take decisive conversion surgery, surgery to reduce the difficulty and shorten the operation time to reduce the amount of bleeding, to minimize trauma.
引文
[1] Wallach EE, Vlahos NF.Uterine myomas: an overview of development, clinical features, and management[ J]. ObstetGyneco,l 2004, 104: 393-406
[2] Cramer SF, PatelA.The frequency of uterine leiomyomas [J].Am J Clin Patho,l 1990, 94: 435-438
[3] Dessolle L, Soriano D, Poncelet C, et al. Detemr inants of pregnancy rate and obstetric outcome after laparoscopic myomectomy for infertility[J]Fertil Steril,2001,76(2):370-374.
[4]冷金花,张震宇,段华等.子宫肌瘤诊治的热点问题,[J]现代妇产科进展,2007,1(5):321-333
[5] Eltabbakh GH.Effect of surgeon’s experience on the surgical outcome of laparoscopic surgery for women with endometrial cancer.GynecolOncol,2000,78:58～61.
[6] Mais V,Ajossa S,Guerriero S,et al,Laparoscopic versus abdominal myomectomy:a prospective, randomised trial to evaluate benefits in early outcome[J] .Am J Obstet Gynecol, 1996,174:654–658
[7] P.G.Paul,Aby K,Koshy1 ,Tony Thomas ,etal , Pregnancy outcomes following laparoscopic myomectomy and single-layer myometrial closure[J], Human Reproduction,2006 ,21:3278–3281
[8]冯凤芝,冷金花,郎景和.腹腔镜下子宫肌瘤剔除术的临床进展[J].中华妇产科杂志,2004,39(1):65-67.
[9] Dubussion JB, FauconnierA, Fourchotte V, etal , Laparoscopic myomectomy: predicting the risk of conversion to anopen procedure[J].Hum Reprod, 2001, 16: 1726– 1731
[10] Wen-Chiung Hsu,Jing-Shiang Hwang,Wen-Chun Chang, et al,Prediction of operation time for laparoscopic myomectomy by ultrasound measurement[J],Surg Endosc (2007) 21:1600–1606
[11]张震宇.腹腔镜[M]郎景和.妇科学新进展—妇科手术的新观念和新方法.北京:中华医学电子音像出版社, 2006: 66-69
[12]瞿红,张震宇,刘崇东,等DDI评分系统预测腹腔镜子宫肌瘤剔除术的结局, [J]现代妇产科进展,2008,17;73-74
[13] Sumitani H,Shozu M,Segawa T,et al.Sit u Est rogen Synt he sized by Aromatase P450 in uterine leiomyoma cell spromotes cell growth probably via an autocrine/int racrinemechanism. [J]Endocrinology,2000,141:3852-3861.
[14] Maruo T,Mat suo H,Samoto T,et al.Effect s of progesterone on uterine leio-myoma growth and apoptosis. [J]Steroids(United States),2000,65:585-5921
[15] Dixon D,He H,Haseman J K.Immuno histochemical localization of growt h factors and their receptors in uterine leiomyomas and matched myometrium.Envion [J]Health Perspect,2000,108 (Suppl 5):795-8021
[16] Ayman Al-Hendy1 , Salama Salama ,Gene therapy and uterine leiomyoma: a review, [J]Human Reproduction Update, 2006,12(4):385–400
[17]徐苓,子宫肌瘤非手术治疗的理论基础及适应证[J]1中国实用妇科与产科杂志,2001,17,(3)∶1291
[18] FernandezH, SefriouiO,VirelizierC, eta1.Hysterosopic resection of submucosal myomas in patients with infertility. [J] Hum Reprod,2001, 16(7): 1489-1492
[19] Ravina J H,Herbreteau D,Ciraril vignerou N,et al.Arterial embolisation to treat uterine myomata. [J]Lancet,1995,346:671-672.
[20] Goodwin SC, Bradley LD,Lipman JC, et a.l Uterine artery embolization versus myomectomy: a multicenter comparative study. [J] Fertil Steri,l 2006, 85(1): 14-21.
[21] Marshburn PB, Matthews ML, Hurst BS,Uterine artery embolization as a treatment option for uterinemyomas. [J]ObstetGynecolClin NortAm, 2006, 33(1): 125-144.
[22] GuptaJK , SinhaAS, Lumsden MA ,eta.l ,Uterine artery embolization for symptomatic uterine fibroids. [J]Cochrane Database SystRev, 2006,25(1):CD005073.
[23] Vashisht A,Studd J,Carey A,et al.Fatal sepicaemia after fibroid mbolisatian letterc. [J]Lance,1999,354:307-308.
[24] Holzer, S.T.Jirecek, U.M.Illievich, etal, Laparoscopic Versus Open Myomectomy:A Double-Blind Study to Evaluate Postoperative Pain,[J] International Anesthesia Research Society ,2006,102:1480–4
[25] Jay Goldberg, Leonardo Pereira, Pregnancy outcomes following treatment for fibroids:uterine fibroid embolization versus laparoscopic myomectomy[J], Current Opinion in Obstetrics and Gynecology,2006,18:402–406
[26]张玉,王英红,郭晓青,腹腔镜下子宫肌瘤剔除术的临床应用,[J]生物医学工程与临床2008,12(4):303-305
[27] Hiroyuki Takeuchi ,Mari Kitade, Iwaho Kikuchi, et al, Influencing factors of adhesion development and the efficacy of adhesion-preventing agents in patients undergoing laparoscopic myomectomy as evaluated by a second-look laparoscopy[J], American Society for Reproductive Medicine,2008,89:1247–53.
[28] Fauconnier A,Chapron C,Babaki-Fard K,etal.Recurrence of leiomyoma after myomectomy[J].Hum Reprod Update,2000,6(6):595-602.
[29] Izumi Imaoka, Akihiko Wada, Michimasa Matsuo, et al, MR Imaging of Disorders Associated with Female Infertility:Use in Diagnosis,Treatment,and Management[J], RadioGraphics 2003,23:1401–1421
[30] ShimanukiH, TakeuchiH, KikuchiI,etal.Effectiveness of intraoperative ultrasound inreducing recurrent fibroids during laparoscopic myomectomy [J].JReprod Med , 2006, 51(9):683-688.
[31] WANG Ying-hong,GUO Xiao-qing,ZHAO Xia.A comparison between laparoscopic and open myomectomy[J].Chinese Journal of Minimally Invasive Surgery,2006, 6(8):613-615
[32] Parker WH,Iacampo K,Long T.Uterine rupture after laparoscopic removal of a pedunculated myoma[J].J Minim InvasiveGynecol,2007,14(3):362-364.
[33] Malartic C,Morel O,Akerman G,et al.Laparoscopic myomectomy in 2007:state of the art[J].J Gynecol Obstet Biol Reprod(Paris),2007,36(6):567-576.
[34] Malberti S,Ferrari L,Milani R.Spontaneous uterine rupture in the third trimester of gestationater laparoscopic myomectomy Acaserreport [J]Minerva Ginecol ,2004, 56(5):479-480
[35] Dubuisson JB,Fauconnier A,Chapron C,et al.Second look after laparoscopic myomoctomy [J].Hum Reprod,1998,13(8):2102-2106.
[36] C.Altgassen,S.Kuss,U.Berger, et al.Complications in laparoscopic myomectomy [J].Surg Endosc2006(20):614–618
[37]米鑫,姚书忠,刘莉,等.腹腔镜大径线肌壁间子宫肌瘤剔除术的临床分析[J].中国内镜杂志,2006,12(7):717-719.
[38]郭晓青,王英红,阿曼古丽.腹腔镜巨大子宫肌瘤切除术147例报告[J].腹腔镜外科杂志,2006,11(1):8-9.
[39]许学岚,张娟娟,王春平,腹腔镜下复杂子宫肌瘤剔除术的可行性分析[J]中华妇产科杂志2006,41(7):464-466.
[40] LANG Jing-he,LENG Jin-hua.The hot spots on laparoscopy [J].Chinese Journal of Modern Operative Surgery, 2004,13(2):81-91.[郎景和,冷金花.腹腔镜手术的热点问题讨论[J].现代妇产科进展,2004,13(2):81-91.]
[41] Z .Liang,H ,Xu,Y. Chen, Y .Li,Q .Zhang, et al,Laparoscopic blockage of uterine artery and myomectomy A new method of treating symptomatic uterine leiomyomas[J],Surg Endosc,2006,20:983–986
[42] Martin Voss,Christhardt Koehler,Florian Elger, et al,Temporary clipping of the uterine artery during laparoscopic myomectomy—a new technique and the results of first cases [J],Gynecol Surg,2007,4:101–105
[43]成九梅,刘芸,段华等,线圈套扎法在腹腔镜子宫肌瘤剔除术中的应用[J],中国实用妇科与产科杂志,2007,23(5):376-377
[44] Hyo Jin Yoon, Min Sun Kyung, Laparoscopic Myomectomy for Large Myomas [J]. J Korean Med Sci ,2007,22:706-12
[45] Magdi Hanafi, Predictors of Leiomyoma Recurrence After Myomectomy[J], Obstet Gynecol,2005,105:877-81
[46]施如霞,郑虹,蒋鹏程,谢晔玲,丁玲,腹腔镜下宫颈肌瘤剔除术的临床分析[J]中国内镜杂志2008,14(3)278-280
[47]纪毅梅,余晓,腹腔镜下阔韧带肌瘤剥除术15例临床分析[J]临床医学2008,28(2):84-85
[48] Di Gregorio A, Maccario S,Raspollini M,The role of laparoscopic myomectomy in women of reproductive age[J].Reprod Biomed Online,2002,4(3):55-58.
[49]林彤,王黎明,武风芝.经腹腔镜子宫肌瘤剥除术(附20例分析)[J].中国内镜杂志,2001,7(5):77-78.
[50]夏恩兰,主编.妇科内镜学[M].北京:人民卫生出版社,2001:368-373.
[51]刘木彪,何授利,张凌云,等.1788例妇科腹腔镜手术的临床应用体会[J].中国内镜杂志,2003,9(11):79-80.
[52] Takeuchi H,Kuwatsuru R.The indications,surgical techniques,and limitations of laparoscopic myomectomy.Journal of he Society of Laparoendoscopic Surgeons [J]. Society of Laparoendoscopic Surgeons,2003,7(2):89-95.
[53]孙华,张勇,郑建等,宫腔镜治疗子宫黏膜下肌瘤72例[J]中国微创外科杂志, 2005, 5(3): 198-199.
[54]黄浩梁,曹丽蓉,孟红娟等,宫腔镜电切术治疗子宫黏膜下肌瘤168例分析[J]2009, 9(1): 41-42.
[55]邓文忠,陶桂娥,谢淑蓉等,指助法在腹腔镜子宫肌瘤剔除术中的应用[J],中国妇幼保健,2008,23(7):1020-1021
[56] Guyatt GH, Townsend M, Berman LB, Keller JL. A comparison of Likert and visual analogue scales for measuring change in function.[J].J.Chronic Dis. 1987;40 : 1129–1133..
[1]丰有吉,沈铿等,妇产科学[M],人民卫生出版社,2005: 322-325
[2] Dessolle L, Soriano D, Poncelet C, et al. Detemr inants of pregnancy rate and obstetric outcome after laparoscopic myomectomy for infertility[J] .Fertil Steril,2001, 76(2):370-374.
[3]冷金花,张震宇,段华等.子宫肌瘤诊治的热点问题,现代妇产科进展[J],2007,15(5):321-333
[4] P.G.Paul,Aby K,Koshy1,Tony Thomas,etal,Pregnancy outcomes following laparoscopic myomectomy and single-layer myometrial closure[J],Human Repro- duction, 2006 ,21:3278–3281
[5] Mais V, Ajossa S, Guerriero S,et al, Laparoscopic versus abdominal myomectomy:a prospective,randomised trial to evaluate benefits in early outcome[J] .Am J Obstet Gynecol, 1996,174:654–658
[6] Hyo Jin Yoon, Min Sun Kyung, Laparoscopic Myomectomy for Large Myomas [J]. J Korean Med Sci ,2007,22:706-12
[7] P. Litta, E. Cosmi, G.B.Nardelli ,et al,Laparoscopic myomectomy following GnRH therapy[J] ,International Journal of Gynecology and Obstetrics,2005,88;63—64
[8]瞿红,张震宇,刘崇东, DDI评分系统预测腹腔镜子宫肌瘤剔除术的结局[J],现代妇产科进展,2008,17(1);73-74
[9]边爱平,赵倩,周华腹腔镜子宫肌瘤切除术临床效果评估[J]中国实用妇科与产科杂志,2008,24(1):65-66
[10] Magdi Hanafi, Predictors of Leiomyoma Recurrence After Myomectomy[J], Obstet Gynecol,2005,105:877-81
[11] Izumi Imaoka, Akihiko Wada, Michimasa Matsuo, et al, MR Imaging of Disorders Associated with Female Infertility:Use in Diagnosis,Treatment,and Management[J], RadioGraphics 2003,23:1401–1421
[12] Stefano Palomba,aErrico Zupi,bAngela Falbo,et al, A multicenter randomized,controlled study comparing laparoscopic versus minilaparotomic myomectomy: reproductive outcomes[J] ,Fertil Steril,2007,88:933–41
[13] Dubuisson JB, Fauconnier A, Dearges JV, et al, Pregnancy outcome and deliveries following laparoscopic myomectomy[J] .Hum Reprod,2000,15(4):869–873
[14] Peter S.Yeh, Spontaneous antenatal uterine rupture 3 years after laparoscopic myomectomy[J], Gynecol Surg,2005,2:305–306
[15] Hiroyuki Takeuchi ,Mari Kitade, Iwaho Kikuchi, et al, Influencing factors of adhesion development and the efficacy of adhesion-preventing agents in patients undergoing laparoscopic myomectomy as evaluated by a second-look laparoscopy[J], American Society for Reproductive Medicine,2008,89:1247–53.
[16] [16]E.Dumousset, P.Chabrot, B.Rabischong, et al,Preoperative Uterine Artery Embolization (PUAE)Before Uterine Fibroid Myomectomy[J],Cardiovasc Intervent Radiol,2008,31:514–520
[17] Z .Liang,H , Xu,Y. Chen, Y .Li,Q .Zhang, et al,Laparoscopic blockage of uterine artery and myomectomy A new method of treating symptomatic uterine leiomyomas[J], Surg Endosc,2006,20:983–986
[18] Martin Voss,Christhardt Koehler,Florian Elger, et al, Temporary clipping of the uterine artery during laparoscopic myomectomy—a new technique and the results of first cases [J],Gynecol Surg,2007,4:101–105
[19]成九梅,刘芸,段华等,线圈套扎法在腹腔镜子宫肌瘤剔除术中的应用[J],中国实用妇科与产科杂志,2007,23(5):376-377
[20]邓文忠,陶桂娥,谢淑蓉等,指助法在腹腔镜子宫肌瘤剔除术中的应用[J],中国妇幼保健,2008,23(7):1020-1021
[21] P.G.Paul,Aby Koshy,Tony Thomas, et al, Laparoscopic myomectomy:feasibility and safety—a retrospective s]tudy of 762 cases[J], Gynecol Surg,2006,3:97–102
[22] Holzer, S.T.Jirecek, U.M.Illievich, et al, Laparoscopic Versus Open Myomectomy:A Double-Blind Study to Evaluate Postoperative Pain[J], International Anesthesia Research Society ,2006,102:1480–4
[23] Jay Goldberg, Leonardo Pereira, Pregnancy outcomes following treatment for fibroids:uterine fibroid embolization versus laparoscopic myomectomy[J], Current Opinion in Obstetrics and Gynecology,2006,18:402–406
[24] Koji Mikami, Takamichi Murakami, Atsuya Okada, et al, Magnetic resonance imaging-guided focused ultrasound ablation ofuterine fibroids:early clinical experience[J], Radiat Med,2008,26:198–205
[25] J.Rabinovici1, Y.Inbar, S.C.Eylon, et al ,Pregnancy and live birth after focused ultrasound surgery for symptomatic focal adenomyosis:a case report[J],Human Reproduction ,2006,21:1255–1259
[2] Cramer SF, PatelA.The frequency of uterine leiomyomas [J].Am J Clin Patho,l 1990, 94: 435-438
[3] Dessolle L, Soriano D, Poncelet C, et al. Detemr inants of pregnancy rate and obstetric outcome after laparoscopic myomectomy for infertility[J]Fertil Steril,2001,76(2):370-374.
[4]冷金花,张震宇,段华等.子宫肌瘤诊治的热点问题,[J]现代妇产科进展,2007,1(5):321-333
[5] Eltabbakh GH.Effect of surgeon’s experience on the surgical outcome of laparoscopic surgery for women with endometrial cancer.GynecolOncol,2000,78:58～61.
[6] Mais V,Ajossa S,Guerriero S,et al,Laparoscopic versus abdominal myomectomy:a prospective, randomised trial to evaluate benefits in early outcome[J] .Am J Obstet Gynecol, 1996,174:654–658
[7] P.G.Paul,Aby K,Koshy1 ,Tony Thomas ,etal , Pregnancy outcomes following laparoscopic myomectomy and single-layer myometrial closure[J], Human Reproduction,2006 ,21:3278–3281
[8]冯凤芝,冷金花,郎景和.腹腔镜下子宫肌瘤剔除术的临床进展[J].中华妇产科杂志,2004,39(1):65-67.
[9] Dubussion JB, FauconnierA, Fourchotte V, etal , Laparoscopic myomectomy: predicting the risk of conversion to anopen procedure[J].Hum Reprod, 2001, 16: 1726– 1731
[10] Wen-Chiung Hsu,Jing-Shiang Hwang,Wen-Chun Chang, et al,Prediction of operation time for laparoscopic myomectomy by ultrasound measurement[J],Surg Endosc (2007) 21:1600–1606
[11]张震宇.腹腔镜[M]郎景和.妇科学新进展—妇科手术的新观念和新方法.北京:中华医学电子音像出版社, 2006: 66-69
[12]瞿红,张震宇,刘崇东,等DDI评分系统预测腹腔镜子宫肌瘤剔除术的结局, [J]现代妇产科进展,2008,17;73-74
[13] Sumitani H,Shozu M,Segawa T,et al.Sit u Est rogen Synt he sized by Aromatase P450 in uterine leiomyoma cell spromotes cell growth probably via an autocrine/int racrinemechanism. [J]Endocrinology,2000,141:3852-3861.
[14] Maruo T,Mat suo H,Samoto T,et al.Effect s of progesterone on uterine leio-myoma growth and apoptosis. [J]Steroids(United States),2000,65:585-5921
[15] Dixon D,He H,Haseman J K.Immuno histochemical localization of growt h factors and their receptors in uterine leiomyomas and matched myometrium.Envion [J]Health Perspect,2000,108 (Suppl 5):795-8021
[16] Ayman Al-Hendy1 , Salama Salama ,Gene therapy and uterine leiomyoma: a review, [J]Human Reproduction Update, 2006,12(4):385–400
[17]徐苓,子宫肌瘤非手术治疗的理论基础及适应证[J]1中国实用妇科与产科杂志,2001,17,(3)∶1291
[18] FernandezH, SefriouiO,VirelizierC, eta1.Hysterosopic resection of submucosal myomas in patients with infertility. [J] Hum Reprod,2001, 16(7): 1489-1492
[19] Ravina J H,Herbreteau D,Ciraril vignerou N,et al.Arterial embolisation to treat uterine myomata. [J]Lancet,1995,346:671-672.
[20] Goodwin SC, Bradley LD,Lipman JC, et a.l Uterine artery embolization versus myomectomy: a multicenter comparative study. [J] Fertil Steri,l 2006, 85(1): 14-21.
[21] Marshburn PB, Matthews ML, Hurst BS,Uterine artery embolization as a treatment option for uterinemyomas. [J]ObstetGynecolClin NortAm, 2006, 33(1): 125-144.
[22] GuptaJK , SinhaAS, Lumsden MA ,eta.l ,Uterine artery embolization for symptomatic uterine fibroids. [J]Cochrane Database SystRev, 2006,25(1):CD005073.
[23] Vashisht A,Studd J,Carey A,et al.Fatal sepicaemia after fibroid mbolisatian letterc. [J]Lance,1999,354:307-308.
[24] Holzer, S.T.Jirecek, U.M.Illievich, etal, Laparoscopic Versus Open Myomectomy:A Double-Blind Study to Evaluate Postoperative Pain,[J] International Anesthesia Research Society ,2006,102:1480–4
[25] Jay Goldberg, Leonardo Pereira, Pregnancy outcomes following treatment for fibroids:uterine fibroid embolization versus laparoscopic myomectomy[J], Current Opinion in Obstetrics and Gynecology,2006,18:402–406
[26]张玉,王英红,郭晓青,腹腔镜下子宫肌瘤剔除术的临床应用,[J]生物医学工程与临床2008,12(4):303-305
[27] Hiroyuki Takeuchi ,Mari Kitade, Iwaho Kikuchi, et al, Influencing factors of adhesion development and the efficacy of adhesion-preventing agents in patients undergoing laparoscopic myomectomy as evaluated by a second-look laparoscopy[J], American Society for Reproductive Medicine,2008,89:1247–53.
[28] Fauconnier A,Chapron C,Babaki-Fard K,etal.Recurrence of leiomyoma after myomectomy[J].Hum Reprod Update,2000,6(6):595-602.
[29] Izumi Imaoka, Akihiko Wada, Michimasa Matsuo, et al, MR Imaging of Disorders Associated with Female Infertility:Use in Diagnosis,Treatment,and Management[J], RadioGraphics 2003,23:1401–1421
[30] ShimanukiH, TakeuchiH, KikuchiI,etal.Effectiveness of intraoperative ultrasound inreducing recurrent fibroids during laparoscopic myomectomy [J].JReprod Med , 2006, 51(9):683-688.
[31] WANG Ying-hong,GUO Xiao-qing,ZHAO Xia.A comparison between laparoscopic and open myomectomy[J].Chinese Journal of Minimally Invasive Surgery,2006, 6(8):613-615
[32] Parker WH,Iacampo K,Long T.Uterine rupture after laparoscopic removal of a pedunculated myoma[J].J Minim InvasiveGynecol,2007,14(3):362-364.
[33] Malartic C,Morel O,Akerman G,et al.Laparoscopic myomectomy in 2007:state of the art[J].J Gynecol Obstet Biol Reprod(Paris),2007,36(6):567-576.
[34] Malberti S,Ferrari L,Milani R.Spontaneous uterine rupture in the third trimester of gestationater laparoscopic myomectomy Acaserreport [J]Minerva Ginecol ,2004, 56(5):479-480
[35] Dubuisson JB,Fauconnier A,Chapron C,et al.Second look after laparoscopic myomoctomy [J].Hum Reprod,1998,13(8):2102-2106.
[36] C.Altgassen,S.Kuss,U.Berger, et al.Complications in laparoscopic myomectomy [J].Surg Endosc2006(20):614–618
[37]米鑫,姚书忠,刘莉,等.腹腔镜大径线肌壁间子宫肌瘤剔除术的临床分析[J].中国内镜杂志,2006,12(7):717-719.
[38]郭晓青,王英红,阿曼古丽.腹腔镜巨大子宫肌瘤切除术147例报告[J].腹腔镜外科杂志,2006,11(1):8-9.
[39]许学岚,张娟娟,王春平,腹腔镜下复杂子宫肌瘤剔除术的可行性分析[J]中华妇产科杂志2006,41(7):464-466.
[40] LANG Jing-he,LENG Jin-hua.The hot spots on laparoscopy [J].Chinese Journal of Modern Operative Surgery, 2004,13(2):81-91.[郎景和,冷金花.腹腔镜手术的热点问题讨论[J].现代妇产科进展,2004,13(2):81-91.]
[41] Z .Liang,H ,Xu,Y. Chen, Y .Li,Q .Zhang, et al,Laparoscopic blockage of uterine artery and myomectomy A new method of treating symptomatic uterine leiomyomas[J],Surg Endosc,2006,20:983–986
[42] Martin Voss,Christhardt Koehler,Florian Elger, et al,Temporary clipping of the uterine artery during laparoscopic myomectomy—a new technique and the results of first cases [J],Gynecol Surg,2007,4:101–105
[43]成九梅,刘芸,段华等,线圈套扎法在腹腔镜子宫肌瘤剔除术中的应用[J],中国实用妇科与产科杂志,2007,23(5):376-377
[44] Hyo Jin Yoon, Min Sun Kyung, Laparoscopic Myomectomy for Large Myomas [J]. J Korean Med Sci ,2007,22:706-12
[45] Magdi Hanafi, Predictors of Leiomyoma Recurrence After Myomectomy[J], Obstet Gynecol,2005,105:877-81
[46]施如霞,郑虹,蒋鹏程,谢晔玲,丁玲,腹腔镜下宫颈肌瘤剔除术的临床分析[J]中国内镜杂志2008,14(3)278-280
[47]纪毅梅,余晓,腹腔镜下阔韧带肌瘤剥除术15例临床分析[J]临床医学2008,28(2):84-85
[48] Di Gregorio A, Maccario S,Raspollini M,The role of laparoscopic myomectomy in women of reproductive age[J].Reprod Biomed Online,2002,4(3):55-58.
[49]林彤,王黎明,武风芝.经腹腔镜子宫肌瘤剥除术(附20例分析)[J].中国内镜杂志,2001,7(5):77-78.
[50]夏恩兰,主编.妇科内镜学[M].北京:人民卫生出版社,2001:368-373.
[51]刘木彪,何授利,张凌云,等.1788例妇科腹腔镜手术的临床应用体会[J].中国内镜杂志,2003,9(11):79-80.
[52] Takeuchi H,Kuwatsuru R.The indications,surgical techniques,and limitations of laparoscopic myomectomy.Journal of he Society of Laparoendoscopic Surgeons [J]. Society of Laparoendoscopic Surgeons,2003,7(2):89-95.
[53]孙华,张勇,郑建等,宫腔镜治疗子宫黏膜下肌瘤72例[J]中国微创外科杂志, 2005, 5(3): 198-199.
[54]黄浩梁,曹丽蓉,孟红娟等,宫腔镜电切术治疗子宫黏膜下肌瘤168例分析[J]2009, 9(1): 41-42.
[55]邓文忠,陶桂娥,谢淑蓉等,指助法在腹腔镜子宫肌瘤剔除术中的应用[J],中国妇幼保健,2008,23(7):1020-1021
[56] Guyatt GH, Townsend M, Berman LB, Keller JL. A comparison of Likert and visual analogue scales for measuring change in function.[J].J.Chronic Dis. 1987;40 : 1129–1133..
[1]丰有吉,沈铿等,妇产科学[M],人民卫生出版社,2005: 322-325
[2] Dessolle L, Soriano D, Poncelet C, et al. Detemr inants of pregnancy rate and obstetric outcome after laparoscopic myomectomy for infertility[J] .Fertil Steril,2001, 76(2):370-374.
[3]冷金花,张震宇,段华等.子宫肌瘤诊治的热点问题,现代妇产科进展[J],2007,15(5):321-333
[4] P.G.Paul,Aby K,Koshy1,Tony Thomas,etal,Pregnancy outcomes following laparoscopic myomectomy and single-layer myometrial closure[J],Human Repro- duction, 2006 ,21:3278–3281
[5] Mais V, Ajossa S, Guerriero S,et al, Laparoscopic versus abdominal myomectomy:a prospective,randomised trial to evaluate benefits in early outcome[J] .Am J Obstet Gynecol, 1996,174:654–658
[6] Hyo Jin Yoon, Min Sun Kyung, Laparoscopic Myomectomy for Large Myomas [J]. J Korean Med Sci ,2007,22:706-12
[7] P. Litta, E. Cosmi, G.B.Nardelli ,et al,Laparoscopic myomectomy following GnRH therapy[J] ,International Journal of Gynecology and Obstetrics,2005,88;63—64
[8]瞿红,张震宇,刘崇东, DDI评分系统预测腹腔镜子宫肌瘤剔除术的结局[J],现代妇产科进展,2008,17(1);73-74
[9]边爱平,赵倩,周华腹腔镜子宫肌瘤切除术临床效果评估[J]中国实用妇科与产科杂志,2008,24(1):65-66
[10] Magdi Hanafi, Predictors of Leiomyoma Recurrence After Myomectomy[J], Obstet Gynecol,2005,105:877-81
[11] Izumi Imaoka, Akihiko Wada, Michimasa Matsuo, et al, MR Imaging of Disorders Associated with Female Infertility:Use in Diagnosis,Treatment,and Management[J], RadioGraphics 2003,23:1401–1421
[12] Stefano Palomba,aErrico Zupi,bAngela Falbo,et al, A multicenter randomized,controlled study comparing laparoscopic versus minilaparotomic myomectomy: reproductive outcomes[J] ,Fertil Steril,2007,88:933–41
[13] Dubuisson JB, Fauconnier A, Dearges JV, et al, Pregnancy outcome and deliveries following laparoscopic myomectomy[J] .Hum Reprod,2000,15(4):869–873
[14] Peter S.Yeh, Spontaneous antenatal uterine rupture 3 years after laparoscopic myomectomy[J], Gynecol Surg,2005,2:305–306
[15] Hiroyuki Takeuchi ,Mari Kitade, Iwaho Kikuchi, et al, Influencing factors of adhesion development and the efficacy of adhesion-preventing agents in patients undergoing laparoscopic myomectomy as evaluated by a second-look laparoscopy[J], American Society for Reproductive Medicine,2008,89:1247–53.
[16] [16]E.Dumousset, P.Chabrot, B.Rabischong, et al,Preoperative Uterine Artery Embolization (PUAE)Before Uterine Fibroid Myomectomy[J],Cardiovasc Intervent Radiol,2008,31:514–520
[17] Z .Liang,H , Xu,Y. Chen, Y .Li,Q .Zhang, et al,Laparoscopic blockage of uterine artery and myomectomy A new method of treating symptomatic uterine leiomyomas[J], Surg Endosc,2006,20:983–986
[18] Martin Voss,Christhardt Koehler,Florian Elger, et al, Temporary clipping of the uterine artery during laparoscopic myomectomy—a new technique and the results of first cases [J],Gynecol Surg,2007,4:101–105
[19]成九梅,刘芸,段华等,线圈套扎法在腹腔镜子宫肌瘤剔除术中的应用[J],中国实用妇科与产科杂志,2007,23(5):376-377
[20]邓文忠,陶桂娥,谢淑蓉等,指助法在腹腔镜子宫肌瘤剔除术中的应用[J],中国妇幼保健,2008,23(7):1020-1021
[21] P.G.Paul,Aby Koshy,Tony Thomas, et al, Laparoscopic myomectomy:feasibility and safety—a retrospective s]tudy of 762 cases[J], Gynecol Surg,2006,3:97–102
[22] Holzer, S.T.Jirecek, U.M.Illievich, et al, Laparoscopic Versus Open Myomectomy:A Double-Blind Study to Evaluate Postoperative Pain[J], International Anesthesia Research Society ,2006,102:1480–4
[23] Jay Goldberg, Leonardo Pereira, Pregnancy outcomes following treatment for fibroids:uterine fibroid embolization versus laparoscopic myomectomy[J], Current Opinion in Obstetrics and Gynecology,2006,18:402–406
[24] Koji Mikami, Takamichi Murakami, Atsuya Okada, et al, Magnetic resonance imaging-guided focused ultrasound ablation ofuterine fibroids:early clinical experience[J], Radiat Med,2008,26:198–205
[25] J.Rabinovici1, Y.Inbar, S.C.Eylon, et al ,Pregnancy and live birth after focused ultrasound surgery for symptomatic focal adenomyosis:a case report[J],Human Reproduction ,2006,21:1255–1259