医学
肌瘤
宫腔镜检查
子宫切除术
子宫肌瘤
平滑肌瘤
不育
外科
流产
子宫腔
子宫
怀孕
遗传学
生物
内科学
作者
J. Friedman,Jacqueline M. K. Wong,A. Chaudhari,Susan Tsai,Magdy P. Milad
出处
期刊:Current Opinion in Obstetrics & Gynecology
[Ovid Technologies (Wolters Kluwer)]
日期:2018-08-01
卷期号:30 (4): 243-251
被引量:22
标识
DOI:10.1097/gco.0000000000000475
摘要
Submucosal uterine leiomyomas are a common benign pelvic tumor that can cause abnormal uterine bleeding and may contribute to infertility and miscarriage. Hysteroscopic myomectomy is the treatment of choice to alleviate bleeding from these myomas and to normalize the uterine cavity. This review discusses the techniques and recent evidence for hysteroscopic myomectomy and examines the two primary surgical tools employed today: the bipolar resectoscope and hysteroscopic mechanical morcellator.Hysteroscopic myomectomy has been a popular treatment for symptomatic submucosal fibroids for decades; it is a minimally invasive, low-cost, low-risk procedure, and is associated with high patient satisfaction. There have been rapid advances in the surgical technology available for this procedure. Both the bipolar resectoscope and the hysteroscopic mechanical morcellator are appropriate tools to remove submucosal myomas. Although the hysteroscopic morcellators have been associated with shortened operative time and a decreased learning curve, the data are limited for their use on type 2 fibroids. The strength of the bipolar resectoscope lies in its ability to resect deeper type 2 fibroids.The evidence suggests that no one technique should be used for all patients, but rather a choice of technique should be taken on a case-by-case basis, depending on the myoma number, size, type, and location. Gynecologists must become knowledgeable about each of these techniques and their associated risks to safely offer these surgeries to their patients.
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