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1.
JNMA J Nepal Med Assoc ; 60(250): 577-580, 2022 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-35690986

RESUMO

Uterine leiomyoma is the most common benign tumour of the female reproductive tract originating from the uterine smooth muscle causing morbidity and impairing their quality of life. It is common among women in the age group 30 to 50 years of age. Women are usually asymptomatic or may present with various symptoms such as abnormal uterine bleeding, pelvic pain, dysmenorrhea, and change in bowel and bladder habits due to pressure symptoms. It is one of the leading causes of hysterectomy. Women with uterine leiomyoma can be managed medically and surgically. Gonadotropin-releasing hormone analogue is one of the modalities used preoperatively to reduce the size of large uterine fibroid. We present the case report of a 36-year-old nulligravida who underwent total abdominal hysterectomy with bilateral salpingectomy for large uterine leiomyoma weighing 5.61 kg without compression symptoms. She received a gonadotropin-releasing hormone agonist (injection leuprolide) preoperatively for reduction of the size of uterine myoma. Keywords: case reports; gonadotropin-releasing hormone; hysterectomy; leiomyoma.


Assuntos
Leiomioma , Neoplasias Uterinas , Adulto , Antineoplásicos Hormonais/uso terapêutico , Feminino , Hormônio Liberador de Gonadotropina/uso terapêutico , Humanos , Histerectomia , Leiomioma/complicações , Leiomioma/diagnóstico , Leiomioma/cirurgia , Pessoa de Meia-Idade , Qualidade de Vida , Neoplasias Uterinas/complicações , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/cirurgia
3.
Artigo em Inglês | MEDLINE | ID: mdl-35671230

RESUMO

Leiomyomas are rare benign tumors of the esophagus that account for about 4% of all esophageal tumors. Recently, the great improvements in minimally invasive techniques have made the resection of mediastinal and pulmonary neoplasms more feasible through video-assisted thoracoscopic or robotic surgery. Our video tutorial describes our approach for a right-sided 3-port thoracoscopic resection of an upper esophageal leiomyoma.


Assuntos
Neoplasias Esofágicas , Leiomioma , Procedimentos Cirúrgicos Robóticos , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Humanos , Leiomioma/cirurgia , Mediastino/patologia , Cirurgia Torácica Vídeoassistida/métodos
4.
Int J Hyperthermia ; 39(1): 772-779, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35654459

RESUMO

OBJECTIVE: To investigate the value of the image indexes of B-mode and power Doppler sonography in predicting the therapeutic efficacy of high intensity focused ultrasound (HIFU) ablation for uterine fibroids. MATERIALS AND METHODS: Two hundred and three patients with a solitary uterine fibroid were enrolled in this study. Every patient underwent transvaginal sonography (TVS) and magnetic resonance imaging (MRI) before HIFU. The patients were divided into hypointense, isointense and hyperintense fibroid groups based on T2 weighted MR imaging characteristics, and ultrasonic image indexes of the fibroids in different groups were compared. Multiple linear regression analysis was used to evaluate the correlation between ultrasonic image indexes and energy efficiency factor (EEF), non-perfused volume (NPV) ratio of uterine fibroids. RESULTS: Among them, 72 patients had a hypointense fibroid, 70 had an isointense fibroid and 61 had a hyperintense fibroid. Significant differences were observed in the ultrasound imaging gray scale value difference between the myometrium and uterine fibroids (GSmyo-fib), the ultrasound imaging gray scale value ratio of fibroids over the myometrium (GSfib/myo), and the ratio of power Doppler pixel area to fibroid area (PDPA/FA) among the three groups (p < 0.05). Linear regression analysis showed that the PDPA/FA and the location of fibroids were the factors affecting the NPV ratio, a model for predicting the NPV ratio was established. CONCLUSIONS: A model with the PDPA/FA for NPV ratio could be used to predict the therapeutic efficacy of HIFU for fibroids.


Assuntos
Ablação por Ultrassom Focalizado de Alta Intensidade , Leiomioma , Neoplasias Uterinas , Feminino , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Humanos , Leiomioma/diagnóstico por imagem , Leiomioma/patologia , Leiomioma/cirurgia , Resultado do Tratamento , Ultrassonografia , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/cirurgia
5.
JSLS ; 26(2)2022.
Artigo em Inglês | MEDLINE | ID: mdl-35655468

RESUMO

Objective: To identify pre-operative and intraoperative factors associated with the risk of red blood cell transfusion among women undergoing hysterectomy. Methods: A retrospective cohort study of hysterectomy for benign indications between January 1, 2011 - December 31, 2017. Patients receiving blood transfusion within 30 days of surgery were compared to patients who did not receive any transfusion. Multivariate logistic regression analysis was performed to identify clinical and surgical variables associated with blood transfusion. Results: Among 171,940 women who underwent hysterectomy for benign indication, 4,667 (2.7%) required blood transfusion. The rate of transfusion was highest among patients with uterine fibroids (4.3%) and lowest in patients with genital prolapse (1.1%) (p < 0.05). Odds of blood transfusion were significantly elevated in patients undergoing hysterectomy for uterine fibroids compared to patients with genital prolapse (adjusted odds ratio [aOR] 1.36, 95% confidence interval [CI] 1.15 - 1.61). Other patient characteristics included body mass index, smoking, bleeding disorders, pre-operative sepsis, and American Society of Anesthesiologists score ≥ 2 (p < 0.05). Higher pre-operative hematocrit significantly decreased the risk of blood transfusion (aOR 0.84, 95% CI 0.84 - 0.85 per percent increase in hematocrit). Abdominal and vaginal hysterectomies were associated with greater odds of transfusion compared with laparoscopic approaches (aOR 5.06, 95% CI 4.70 - 5.44; aOR 1.87, 95% CI 1.67 - 2.10, respectively). Conclusions: Certain patient comorbidities, surgical indication, and approach to hysterectomy are associated with increased risk of blood transfusion. These results may have implications for pre-operative patient counseling, perioperative care, and health system planning.


Assuntos
Histerectomia , Leiomioma , Transfusão de Sangue , Feminino , Humanos , Histerectomia Vaginal , Leiomioma/cirurgia , Estudos Retrospectivos
7.
J Int Med Res ; 50(5): 3000605221102087, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35634930

RESUMO

OBJECTIVE: To evaluate the effect of different levels of physician experience on the high-intensity focused ultrasound (HIFU) ablation of uterine fibroids and to provide a reference for the use of non-perfused volume ratio (NPVR) standards during training. METHODS: This prospective multicentre study enrolled patients with uterine fibroids. The effect of the physician's level of experience on the outcomes under different NPVR standards and the learning curve of six centres without HIFU experience were analysed. The impact of patient demographic and clinical characteristics were also evaluated. RESULTS: A total of 1352 patients from 20 centres were included in the study. The median NPVRs were 92.00%, 88.10% and 92.86% in the no experience group, inexperienced group and experienced group, respectively. Posterior wall fibroids, lateral wall fibroids and fundus fibroids were inversely correlated with NPVR, while experienced physicians were positively correlated with NPVR. With NPVR ≥ 70% and NPVR ≥ 80% standards, physicians in the no experience group completed the learning curve on the 11th and 16th procedure, respectively. Physicians under a standard of an NPVR ≥ 90% did not complete the learning curve. CONCLUSIONS: NPVR ≥ 80% is a standard that is worth using for HIFU treatment of uterine fibroids.


Assuntos
Ablação por Ultrassom Focalizado de Alta Intensidade , Leiomioma , Médicos , Neoplasias Uterinas , Feminino , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Humanos , Leiomioma/diagnóstico por imagem , Leiomioma/cirurgia , Estudos Prospectivos , Resultado do Tratamento , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/cirurgia
8.
Obstet Gynecol Clin North Am ; 49(2): 299-314, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35636810

RESUMO

Leiomyomas (fibroids) are common, usually benign, monoclonal tumors that arise from the uterine myometrium. Clinical presentation is variable; some patients are asymptomatic, whereas others experience heavy menstrual bleeding, pain, bulk symptoms, and/or alterations in fertility. Previously, treatment options for fibroids were largely surgical. However, over the last decade, options have grown to include many medical and procedural options that allow for uterine and fertility preservation. Clinicians must become familiar with these options to adequately counsel patients desiring treatment of fibroids.


Assuntos
Preservação da Fertilidade , Leiomioma , Menorragia , Neoplasias Uterinas , Feminino , Humanos , Leiomioma/cirurgia , Menorragia/etiologia , Menorragia/terapia , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/terapia , Útero
9.
Obstet Gynecol Clin North Am ; 49(2): 329-353, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35636812

RESUMO

Hysteroscopic myomectomy is the treatment of choice for symptomatic submucosal myomas, with excellent success rate and low complication rate.


Assuntos
Leiomioma , Miomectomia Uterina , Neoplasias Uterinas , Feminino , Humanos , Histeroscopia , Leiomioma/cirurgia , Gravidez , Neoplasias Uterinas/cirurgia
10.
Fertil Steril ; 118(1): 207-209, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35537898

RESUMO

OBJECTIVE: To perform laparoscopic myomectomy by combining two novel ligation techniques for a large lateral intraligamental myoma. DESIGN: A step-by-step explanation of the surgical procedure using a video with narration. SETTING: University hospital. PATIENT(S): A 39-year-old woman (gravida 1, para 0) presented with an asymptomatic pelvic mass. Sonographic imaging revealed a 10-cm subserous myoma from the right lateral uterine isthmus wall. Laparoscopic exploration revealed a large myoma growing from the right lateral cervical isthmus wall toward the broad ligament. It was protruding into the pararectal space with duplicated ureters. INTERVENTION(S): For such a large lateral intraligamental myoma, any conventional approach has the potential to cause massive bleeding and accidental injuries. We devised and implemented a preventative strategy for intraoperative bleeding by combining two novel ligation techniques used in laparoscopic myomectomy. We made an incision at the posterior leaf of the broad ligament and exposed the myometrium enveloping the fibroid and the base of the fibroid. Then we performed an incision 2 cm away from the right lower edge of the fibroid base, opening the myometrium and pseudocapsule. We applied two novel ligation techniques that ligate the pedicle on the left of the fibroid and the pseudocapsule on the right of the fibroid. Enucleation and loop tightening were implemented simultaneously. The entire pseudocapsule and most of the myometrium enveloping the fibroid were ligated in the loop knot. Only a small portion of the myometrium on the right side was outside the loop knot, which required electrocoagulation. Loop ligation was performed twice more for reinforcement in the same location. The peritoneum was then closed. MAIN OUTCOME MEASURE(S): Laparoscopic myomectomy was completed successfully for a large lateral intraligamental myoma using our novel technique. RESULT(S): The surgery lasted 110 min, and the volume of intraoperative blood loss was 150 mL. The patient had a normal postoperative course. CONCLUSION(S): Combining two novel ligation techniques in laparoscopic myomectomy is a safe and efficient surgical choice. This technique has obvious advantages in large, broad ligament myomas, reducing bleeding and avoiding unintentional injuries, even in duplicated ureters. Furthermore, this technique is not limited by the device and does not increase the cost of surgery.


Assuntos
Laparoscopia , Leiomioma , Mioma , Miomectomia Uterina , Neoplasias Uterinas , Adulto , Feminino , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Leiomioma/diagnóstico por imagem , Leiomioma/cirurgia , Mioma/cirurgia , Miomectomia Uterina/métodos , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/cirurgia
11.
Eur J Obstet Gynecol Reprod Biol ; 274: 128-135, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35640441

RESUMO

OBJECTIVES: Transcervical resection of myoma (TCRM) is a widely implemented treatment for submucous fibroids. The aim of this study is to evaluate the effect of TCRM on menstrual bleeding, fibroid related symptoms and quality of life and hemoglobin (Hb) levels. STUDY DESIGN: A prospective cohort study was conducted in three teaching hospitals and two academic hospitals in the Netherlands. Patients with HMB (PBAC score > 150) and submucous fibroids (type 0, 1, 2, 3, 4 and hybrid type 2-5) scheduled for TCRM were eligible. At baseline and 3 months after TCRM a Trans Vaginal Ultrasound (TVU) was performed and a Hb sample was taken. Patients filled out the Pictorial Blood Assessment Chart (PBAC) and the Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaire at baseline and up to 6 months after surgery. Primary outcome was improvement in PBAC score 6 months after surgery. Secondary outcomes were improvement in PBAC score and Hb level 3 months after surgery and UFS-QOL scores 3 and 6 months after surgery. RESULTS: 126 patients were included and 104 were operated. PBAC were obtained from 98 patients. Six months after surgery, 56.6% of patients went from HMB to normal menstrual bleeding (PBAC < 150). A significant reduction in median PBAC scores of 427 (IQR 198 - 1392) (p <.0001) was found (86% improvement). UFS-QOL scores were obtained from 91 patients. Symptom severity improved from a median of 54 on a scale of 100 (IQR 44-66) at baseline to 22 (IQR 9-41) after 6 months (p <.0001) (59% improvement). Health related quality of life (HRQOL) improved from a median score of 44 on a scale of 100 (IQR 33-62) to 89 (IQR 67-97) 6 months after surgery (p <.0001) (102% improvement). CONCLUSION: TCRM significantly reduces the amount of menstrual bleeding, severity of fibroid related symptoms and improves HRQOL in patients with submucous fibroids.


Assuntos
Leiomioma , Menorragia , Neoplasias Uterinas , Feminino , Hemorragia , Humanos , Leiomioma/complicações , Leiomioma/cirurgia , Menorragia/etiologia , Menorragia/cirurgia , Estudos Prospectivos , Qualidade de Vida , Neoplasias Uterinas/complicações , Neoplasias Uterinas/cirurgia
12.
Curr Oncol ; 29(5): 2935-2940, 2022 04 20.
Artigo em Inglês | MEDLINE | ID: mdl-35621630

RESUMO

Leiomyomas are a common type of benign soft tissue tumor arising from smooth muscle, most often occurring within females' genitourinary and gastrointestinal tract. However, primary leiomyomas of the chest wall residing in the extra-pleural space are an extremely rare subset of leiomyomatous lesion presentation. We present a case of a fifty-two-year-old male who initially presented complaining of dyspnea worsening with exertion. Computed tomography imaging was performed showing an extra-pleural mass residing under the left sixth rib. Subsequent core needle biopsy and immunohistochemical staining were performed, and the definitive diagnosis of primary leiomyoma of the posterior mediastinal chest wall. Although extremely rare, this neoplastic condition should be included in your differential diagnosis when diagnostic imaging reveals a benign mass residing in the extra-pleural space, and subsequent biopsy specimens consist of smooth muscle fibers.


Assuntos
Leiomioma , Neoplasias de Tecidos Moles , Parede Torácica , Feminino , Humanos , Leiomioma/diagnóstico por imagem , Leiomioma/cirurgia , Masculino , Pessoa de Meia-Idade , Pleura/patologia , Tomografia Computadorizada por Raios X
13.
Comput Math Methods Med ; 2022: 9685585, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35607646

RESUMO

Objective: This study aimed to investigate the factors related to pregnancy outcomes after laparoscopic myomectomy. Methods: A retrospective review was conducted on 156 patients aged 18 to 45 years who underwent laparoscopic myomectomy in Ningbo Women and Children's Hospital from January 2010 to December 2016. Follow-up medical records and information were collected on demographic variables, clinical variables, and postoperative pregnancy rate. The logistic regression model was used to assess the association between related factors and postoperative pregnancy rate or pregnancy outcome. The outcome indicators included abortion = 0, premature birth = 1, and full term = 2. The chi-squared test or Fisher's exact test was used to compare the differences in pregnancy outcomes, postpartum hemorrhage, and placenta adhesion between the cohorts. Results: The size of fibroids correlated with the postoperative pregnancy rate. The larger the fibroids, the lower the postoperative pregnancy rate, and the difference was statistically significant. The number of fibroids and placental adhesions was positively associated with postoperative pregnancy; the higher the number of fibroids, the higher the incidence of placental adhesions. However, the postoperative interval of pregnancy, fibroid size, and number and type of fibroids are not correlated with the pregnancy outcomes of postoperative patients. Conclusions: The size of myoma may influence the pregnancy rate of patients after laparoscopic myomectomy. The number of fibroids can affect the incidence of placental adhesions during postoperative pregnancy.


Assuntos
Laparoscopia , Leiomioma , Miomectomia Uterina , Neoplasias Uterinas , Criança , Feminino , Humanos , Laparoscopia/efeitos adversos , Leiomioma/complicações , Leiomioma/epidemiologia , Leiomioma/cirurgia , Placenta , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Miomectomia Uterina/efeitos adversos , Neoplasias Uterinas/complicações , Neoplasias Uterinas/epidemiologia , Neoplasias Uterinas/cirurgia
14.
BMC Surg ; 22(1): 175, 2022 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-35562739

RESUMO

BACKGROUND: The most common complications of myomectomy are intraoperative hemorrhage and postoperative adhesion. The key point to overcome this problem is to improve suture quality. However, to date, there is still no consensus on the optimal method of uterine repair. In this study, we explored the effectiveness and feasibility of single-site laparoscopic parallel mattress sutures to reduce intraoperative bleeding and postoperative adhesion. METHODS: A retrospective cohort analysis was performed, according to the STROBE guidelines, on 124 patients with intramural fibroids admitted between May 2020 and April 2021. The cases were divided into two groups based on the description of the uterine incision suture in the surgical records, including 68 cases in the parallel mattress suture (PMS) group and 56 cases in the simple continuous suture (SCS) group. Operation-related indicators, bleeding indicators, surgical complications, scar reduction index 1 month after surgery, and the incidence of chronic pelvic pain 6 months after the surgery were observed. Independent sample t-tests and Mann-Whitney U tests were performed for the measurement data, and Pearson Chi-square tests were performed for count data. Statistical significance was set at P < 0.05. RESULTS: There was no significant difference in the baseline characteristics between the two groups. All operations were performed under transumbilical single-site laparoscopy without conversion. Compared to the SCS group, the PMS group had earlier postoperative anal exhaust (14.3 ± 6.7 h vs. 19.2 ± 9.6 h, P = 0.002), fewer postoperative hemoglobin drops (7.6 ± 3.7 g/L vs. 11.6 ± 4.3 g/L, P = 0.000), smaller uterine scars (3.7 ± 1.9 cm vs. 5.2 ± 1.8 cm, P = 0.000), and a larger uterine scar reduction index (50.2% vs. 31.0%, P = 0.000) one month after surgery and less chronic pelvic pain 6 months after surgery (2.9% vs. 12.5%, P = 0.016). No difference was found in auxiliary trocar usage, transfusion rate, operation time, hospital stay, or perioperative complications between the two groups. CONCLUSION: Seromuscular parallel mattress sutures during myomectomy can prevent pinhole errhysis of the uterine incision, achieve complete serosal and aesthetic incisions, and reduce postoperative chronic pelvic pain. It is effective and feasible to complete a parallel mattress suture during myomectomy via single-site laparoscopy. Further prospective studies are required to determine its efficacy as well as pregnancy outcomes.


Assuntos
Laparoscopia , Leiomioma , Miomectomia Uterina , Neoplasias Uterinas , Perda Sanguínea Cirúrgica , Cicatriz , Feminino , Humanos , Laparoscopia/métodos , Leiomioma/cirurgia , Dor Pélvica/cirurgia , Estudos Retrospectivos , Técnicas de Sutura , Suturas , Miomectomia Uterina/métodos , Neoplasias Uterinas/cirurgia
15.
BMC Pregnancy Childbirth ; 22(1): 387, 2022 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-35505300

RESUMO

BACKGROUND: To evaluate pregnancy outcomes and the risk of adverse obstetrical outcomes of cesarean myomectomy (CM) compared with cesarean section (CS) only, and to investigate the trend of surgeons in choosing CM. METHODS: A retrospective cohort study was performed on all patients who underwent CS complicated by leiomyoma at two university hospitals between January 2010 and May 2020. All patients were categorized into the CM (341 women) or CS-only (438 women) group. We analyzed the demographic factors, obstetric factors, surgical outcomes, and possible risk factors for adverse outcomes between the two groups. RESULTS: Women who underwent CS only were significantly more likely to have a previous myomectomy and multiple leiomyoma history than women who underwent CM. The gestational age at delivery and pregnancy complications were significantly higher in the CS-only group. The mean size of the leiomyomas was larger in the CM group than in the CS-only group (5.8 ± 3.2 cm vs. 5.2 ± 3.1 cm, P = 0.005). The operation time and history of previous CS and preterm labor were higher in the CM group. The leiomyoma types differed between the two groups. The subserosal type was the most common in the CM group (48.7%), and the intramural type was the most common in the CS-only group. Patients in the CM group had fewer than three leiomyomas than those in the CS-only group. Preterm labor and abnormal presentation were relatively higher in the CM group than in the CS-only group, concerning leiomyoma presence. There were no significant differences in the preoperative and postoperative hemoglobin levels. The size of the leiomyoma (odds ratio [OR] = 1.162; 95% confidence interval [CI]: 1.07-1.25; P < 0.001) and operation time > 60 min (OR = 2.461; 95% CI: 1.45-4.15) were significant independent predictors of adverse outcomes after CM. CONCLUSIONS: CM should be considered a reliable and safe approach to prevent the need for another surgery for remnant leiomyoma. Herein, surgeons performed CM when uterine leiomyomas were large, of the subserosal type, or few. Standardized treatment guidelines for myomectomy during CSs in pregnant women with uterine fibroids should be established.


Assuntos
Leiomioma , Trabalho de Parto Prematuro , Complicações Neoplásicas na Gravidez , Miomectomia Uterina , Neoplasias Uterinas , Cesárea/efeitos adversos , Feminino , Humanos , Recém-Nascido , Leiomioma/cirurgia , Masculino , Trabalho de Parto Prematuro/etiologia , Gravidez , Complicações Neoplásicas na Gravidez/epidemiologia , Complicações Neoplásicas na Gravidez/etiologia , Complicações Neoplásicas na Gravidez/cirurgia , Estudos Retrospectivos , Miomectomia Uterina/efeitos adversos , Neoplasias Uterinas/epidemiologia , Neoplasias Uterinas/cirurgia
16.
Pan Afr Med J ; 41: 180, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35573436

RESUMO

Pyomyoma is a rare complication of uterine fibroid occurring most commonly in pregnancy, post-partum, post-abortion, and post-menopausal periods. It results from infarction, necrosis and secondary infection of leiomyoma. We report a case of 29-year-old primigravida with breech at term co-existing with cystic degenerative uterine fibroid, who presented with recurrent fever and abdominal pain. She had caesarean section and was found to have pyomyoma intraoperatively. She subsequently had drainage of pus, caesarean myomectomy and antibiotics therapy. She had good outcome and was discharged on fifth postoperative day. Pyomyoma should be suspected in pregnant women with leiomyoma, unexplained recurrent fever, abdominal pain and cystic degenerative changes on ultrasound.


Assuntos
Leiomioma , Miomectomia Uterina , Neoplasias Uterinas , Dor Abdominal/complicações , Adulto , Cesárea , Feminino , Febre , Humanos , Leiomioma/complicações , Leiomioma/diagnóstico , Leiomioma/cirurgia , Gravidez , Neoplasias Uterinas/complicações
17.
Health Technol Assess ; 26(22): 1-74, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35435818

RESUMO

BACKGROUND: Uterine fibroids are the most common tumour in women of reproductive age and are associated with heavy menstrual bleeding, abdominal discomfort, subfertility and reduced quality of life. For women wishing to retain their uterus and who do not respond to medical treatment, myomectomy and uterine artery embolisation are therapeutic options. OBJECTIVES: We examined the clinical effectiveness and cost-effectiveness of uterine artery embolisation compared with myomectomy in the treatment of symptomatic fibroids. DESIGN: A multicentre, open, randomised trial with a parallel economic evaluation. SETTING: Twenty-nine UK hospitals. PARTICIPANTS: Premenopausal women who had symptomatic uterine fibroids amenable to myomectomy or uterine artery embolisation were recruited. Women were excluded if they had significant adenomyosis, any malignancy or pelvic inflammatory disease or if they had already had a previous open myomectomy or uterine artery embolisation. INTERVENTIONS: Participants were randomised to myomectomy or embolisation in a 1 : 1 ratio using a minimisation algorithm. Myomectomy could be open abdominal, laparoscopic or hysteroscopic. Embolisation of the uterine arteries was performed under fluoroscopic guidance. MAIN OUTCOME MEASURES: The primary outcome was the Uterine Fibroid Symptom Quality of Life questionnaire (with scores ranging from 0 to 100 and a higher score indicating better quality of life) at 2 years, adjusted for baseline score. The economic evaluation estimated quality-adjusted life-years (derived from EuroQol-5 Dimensions, three-level version, and costs from the NHS perspective). RESULTS: A total of 254 women were randomised - 127 to myomectomy (105 underwent myomectomy) and 127 to uterine artery embolisation (98 underwent embolisation). Information on the primary outcome at 2 years was available for 81% (n = 206) of women. Primary outcome scores at 2 years were 84.6 (standard deviation 21.5) in the myomectomy group and 80.0 (standard deviation 22.0) in the uterine artery embolisation group (intention-to-treat complete-case analysis mean adjusted difference 8.0, 95% confidence interval 1.8 to 14.1, p = 0.01; mean adjusted difference using multiple imputation for missing responses 6.5, 95% confidence interval 1.1 to 11.9). The mean difference in the primary outcome at the 4-year follow-up time point was 5.0 (95% CI -1.4 to 11.5; p = 0.13) in favour of myomectomy. Perioperative and postoperative complications from all initial procedures occurred in similar percentages of women in both groups (29% in the myomectomy group vs. 24% in the UAE group). Twelve women in the uterine embolisation group and six women in the myomectomy group reported pregnancies over 4 years, resulting in seven and five live births, respectively (hazard ratio 0.48, 95% confidence interval 0.18 to 1.28). Over a 2-year time horizon, uterine artery embolisation was associated with higher costs than myomectomy (mean cost £7958, 95% confidence interval £6304 to £9612, vs. mean cost £7314, 95% confidence interval £5854 to £8773), but with fewer quality-adjusted life-years gained (0.74, 95% confidence interval 0.70 to 0.78, vs. 0.83, 95% confidence interval 0.79 to 0.87). The differences in costs (difference £645, 95% confidence interval -£1381 to £2580) and quality-adjusted life-years (difference -0.09, 95% confidence interval -0.11 to -0.04) were small. Similar results were observed over the 4-year time horizon. At a threshold of willingness to pay for a gain of 1 QALY of £20,000, the probability of myomectomy being cost-effective is 98% at 2 years and 96% at 4 years. LIMITATIONS: There were a substantial number of women who were not recruited because of their preference for a particular treatment option. CONCLUSIONS: Among women with symptomatic uterine fibroids, myomectomy resulted in greater improvement in quality of life than did uterine artery embolisation. The differences in costs and quality-adjusted life-years are very small. Future research should involve women who are desiring pregnancy. TRIAL REGISTRATION: This trial is registered as ISRCTN70772394. FUNDING: This study was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme, and will be published in full in Health Technology Assessment; Vol. 26, No. 22. See the NIHR Journals Library website for further project information.


WHAT IS THE PROBLEM?: Uterine fibroids are the most common non-cancerous tumour in women of childbearing age. Uterine fibroids are associated with heavy bleeding, lower chances of having children and reduced quality of life. Traditional surgical options were either to remove the fibroids (via myomectomy) or to completely remove the womb. A newer approach, known as uterine artery embolisation, involves blocking the blood supply to the fibroids in the womb. WHAT DID WE PLAN TO DO?: We compared myomectomy with uterine artery embolisation in women with fibroids who wanted to keep their womb. We wanted to see which treatment improved quality of life, was associated with the fewest complications and was the best value for money for the NHS. We also wanted to see if either treatment had an impact on women's ability to get pregnant and give birth. We included 254 women in a clinical trial. Women were assigned to have myomectomy or uterine artery embolisation at random to ensure a fair comparison. Women completed questionnaires about their symptoms and quality of life at intervals up to 4 years after treatment. WHAT DID WE FIND?: We found that myomectomy improved women's quality of life more than uterine artery embolisation. Complications from the treatments occurred in a similar proportion of women. There appeared to be no difference on reproductive hormone levels between treatments. Too few women in the trial got pregnant for any difference in the numbers of women having children to be seen. The differences in costs and overall disease burden were small. WHAT DOES THIS MEAN?: Both treatments improve quality of life and cost about the same to the NHS but, on average, myomectomy will provide greater benefit to women. There is no evidence to suggest that either treatment is unsuitable for women wanting to get pregnant, but more research is needed in younger women.


Assuntos
Leiomioma , Embolização da Artéria Uterina , Miomectomia Uterina , Feminino , Humanos , Histerectomia , Leiomioma/cirurgia , Masculino , Gravidez , Qualidade de Vida
18.
Zhonghua Fu Chan Ke Za Zhi ; 57(4): 244-252, 2022 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-35484655

RESUMO

Objective: To compare the long-term outcomes after focused ultrasound ablation surgery (FUAS) versus myomectomy for uterine fibroids. Methods: A retrospective study was conducted on women who were treated by FUAS or myomectomy for uterine fibroids at First Medical Center of Chinese PLA General Hospital from January 2007 to January 2015. Regular follow-up was conducted to evaluate the symptoms relief, symptoms recurrence, the need for re-interventions and complications of the two groups. Results: The effective rates were 95.7% (730/763) and 95.5% (1 151/1 205) in women who were treated by FUAS and myomectomy, no statistical difference was seen between the two groups (χ²=0.027, P=0.869). The cumulative rates of symptoms recurrence at 1 year, 3 years, 5 years, 8 years and 10 years of follow-up in FUAS group were 1.8%, 6.8%, 11.9%, 15.2% and 15.9%, respectively; and the cumulative re-intervention rates were 0.7%, 4.1%, 6.8%, 9.9% and 11.0%, respectively. The cumulative rates of symptoms recurrence at 1 year, 3 years, 5 years, 8 years and 10 years of follow-up in myomectomy group were 1.8%, 5.9%, 10.6%, 14.2% and 14.9%, respectively; and the cumulative re-intervention rates were 0.9%, 4.5%, 7.8%, 10.3% and 11.4%, respectively. No statistical differences were seen between the two groups (all P>0.05). There were no significant differences in the effective rate, symptoms recurrence rate and re-intervention rate between the two groups in patients with intermural fibroids; but the effective rate of FUAS (95.9%, 235/245) was higher than that of myomectomy (89.1%, 115/129), the symptoms recurrence rate (11.9%, 28/235) was lower than that of myomectomy (27.8%, 32/115), and the re-intervention rate (7.7%, 18/235) was lower than that of myomectomy (17.4%, 20/115) in patients with submucosal fibroids, there were significant different (all P<0.05). The effective rate of FUAS (91.0%, 132/145) was lower than that of myomectomy (97.0%, 322/332), the symptoms recurrence rate (32.6%, 43/132) was higher than that of myomectomy (9.9%, 32/322), and the re-intervention rate (22.0%, 29/132) was higher than that of myomectomy group (6.2%, 20/132) in patients with subserosal fibroids, there were significant different (all P<0.01). The incidences of total [1.8% (14/763) vs 21.9% (264/1 205)], minor and moderate adverse events were lower in FUAS group than myomectomy group (all P<0.001). Conclusion: Satisfaction with long-term outcomes after FUAS treatment or myomectomy for uterine fibroids is comparable.


Assuntos
Leiomioma , Miomectomia Uterina , Neoplasias Uterinas , Feminino , Humanos , Leiomioma/complicações , Leiomioma/cirurgia , Estudos Retrospectivos , Neoplasias Uterinas/complicações , Neoplasias Uterinas/cirurgia
19.
Sci Rep ; 12(1): 6620, 2022 04 22.
Artigo em Inglês | MEDLINE | ID: mdl-35459918

RESUMO

Uterine fibroid and benign thyroid disease are both common diseases in women. This study aimed to evaluate whether these diseases are related. We established the uterine fibroid group according to diagnosis and surgery codes using the Korea National Health Insurance data from 2009 to 2020. All women from 20 to 50 years old who underwent uterine myomectomy from 2009 to 2020 were identified. We selected the control group by performing a 1:1 propensity score matching on age at 5-year intervals, socioeconomic status (SES), region, Charlson comorbidity index (CCI), menopause, and year among women who visited a medical institution for a health check-up. Thyroid disease cases were selected using the thyroid disease diagnosis code and thyroid-associated laboratory tests. A total of 181,419 patients were included in the uterine fibroid and control groups. The median age of each group was 40 (range, 35 ~ 44) and 40 (range, 35 ~ 45) years old, respectively. Benign thyroid disease affected 1162 (0.6%) in the uterine fibroid group and 1137 (0.6%) in the control group. Among the benign thyroid diseases, hypothyroidism was the most common in both groups, followed by a nontoxic single thyroid nodule. The uterine fibroid group had a higher risk of thyroid goiter (hazard ratio (HR) 1.169, 95% confidence interval (CI) 1.022-1.338), nontoxic single thyroid nodule (HR 1.268, 95% CI 1.182-1.361), and total thyroid disease (HR 1.078, 95% CI 1.036-1.121) in stratified Cox regression analysis adjusted for age, SES, region, CCI, parity, menopause, hypertension, diabetes, dyslipidemia, systemic lupus erythematosus, irritable bowel syndrome, Crohn's disease, and endometriosis than the control group. The results suggest that women with uterine fibroids have an increased risk of thyroid goiters and thyroid nodules. Although the mechanism is not well known, estrogen and iodide might be a link between uterine fibroids and thyroid goiters and nodules. Future studies that prospectively follow women with uterine fibroids across a lifetime are needed.


Assuntos
Bócio , Leiomioma , Nódulo da Glândula Tireoide , Neoplasias Uterinas , Adulto , Pré-Escolar , Feminino , Humanos , Leiomioma/complicações , Leiomioma/epidemiologia , Leiomioma/cirurgia , Masculino , Pessoa de Meia-Idade , Gravidez , Nódulo da Glândula Tireoide/complicações , Nódulo da Glândula Tireoide/epidemiologia , Neoplasias Uterinas/cirurgia , Adulto Jovem
20.
Surg Technol Int ; 40: 190-196, 2022 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-35443283

RESUMO

Electrosurgery in gynecology has changed over the past few decades. The use of energy-based devices, especially in minimally invasive procedures, is extremely important for preparation, short reconvalescence and patient safety. Recently, there have been major advances in energy-based surgical devices that have further shortened OR time and increased patient safety. Although bipolar and monopolar electrosurgery is still very important, the introduction of high-frequency ultrasound in gynecologic surgery has improved cutting and coagulation by lowering thermal damage in the surrounding tissue. Furthermore, new technical inventions have fundamentally changed the treatment of specific diseases. The introduction of ablation in the therapy of uterine fibroids, for example, has made conventional myomectomy no longer necessary in some cases, as necrosis of fibroids can be induced by placing very small thermal probes into the fibroids. Robotic surgery will change the face of gynecological surgery in the near future, as the initial studies could show lower surgical morbidity and faster recovery of patients after robotic-assisted laparoscopy. In this article we provide a short overview of current technical advances, review possible indications as well as limitations, and take a look into the future of minimally invasive surgery in gynecology.


Assuntos
Ginecologia , Laparoscopia , Leiomioma , Eletrocirurgia , Feminino , Procedimentos Cirúrgicos em Ginecologia , Humanos , Laparoscopia/métodos , Leiomioma/diagnóstico por imagem , Leiomioma/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos
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