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首页> 外文期刊>Journal of endometriosis and pelvic pain disorders. >Unplanned hysterectomy following myomectomy at a tertiary institution: A case series and review of the literature
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Unplanned hysterectomy following myomectomy at a tertiary institution: A case series and review of the literature

机译：无计划的子宫切除肌瘤切除术后一个三级机构:一个案例系列和审查文献

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Introduction: Myomectomy is the gold standard uterine-sparing treatment for fibroids. However, the procedure is often complicated by blood loss. In rare cases, haemorrhage may be so severe that a conversion to hysterectomy is warranted. The aim of our study was to investigate the rates of and the clinical reasoning behind unplanned hysterectomies following attempted myomectomies at our institution. Methods: All patients who underwent an open or laparoscopic myomectomy at the Royal Women's Hospital were identified using a gynaecology unit database, maintained from January 2004 to December 2013. Records for patients whose surgeries were unexpectedly converted to a hysterectomy were examined. A review of the literature was also performed, investigating the rates of unplanned hysterectomies following myomectomies. Results: Of the 1501 myomectomies performed, six resulted in an unplanned hysterectomy; an incidence rate of 0.4%. Fibroids were either intramural or pedunculated with the median number of tumours per patient being 2.5 (interquartile range: 1-6). The largest tumour for each patient varied significantly from 4.0x3.2cm to 29.0*25.0cm. In all cases, despite being strongly advised to have a planned hysterectomy, patients insisted on having a myomectomy. Two patients underwent conversion to hysterectomy intraoperatively while the remainder required a return to theatre. Difficulty achieving intraoperative haemostasis (n = 2), and the development of postoperative bleeding and coagulopathy (n = 4) were reasons cited for proceeding to hysterectomy. Conclusion: The rate of conversion from myomectomy to hysterectomy at our institution was low at 0.4%. In all cases, the reason for conversion was difficulty with haemostasis, despite infrequent use of haemostatic agents, and coagulopathy.
机译：作品简介:肌瘤切除术是黄金标准保留子宫肌瘤治疗。失血的程序往往很复杂。在极少数情况下,出血可能非常严重子宫切除术的转换是必要的。我们的研究的目的是调查的比例无计划的背后和临床推理子宫切除后子宫肌瘤未遂在我们的机构。进行了一个开放的或腹腔镜肌瘤切除术皇家女子医院被确定使用一个妇科单位数据库,维护2004年1月至2013年12月。病人的手术意外转换为子宫检查。回顾文献也执行,调查意外的利率子宫切除子宫肌瘤。1501年的子宫肌瘤,六个了在计划外子宫切除术;的0.4%。有梗的平均数量的肿瘤每名患者为2.5(四分位范围:1 - 6)。最大的为每个病人不同的肿瘤明显从4.0 x3.2cm 29.0 * 25.0厘米。所有情况下,尽管强烈建议计划子宫切除,病人坚持肌瘤切除术。转换为子宫切除术术其余需要回到剧院。困难达到术中止血法(n = 2),术后的发展出血、凝血障碍(n = 4)的原因引用进行子宫切除。的速度转换从肌瘤切除术子宫切除术在我们机构低0.4%。在所有情况下,转换的原因止血困难,尽管罕见的使用止血剂的代理,凝血障碍。

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