当科にて腹腔鏡下子宮筋腫核出術を反復した19症例が再手術に至った要因についての検討

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  • Analysis of 19 Cases of Repeat Laparoscopic Myomectomy

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Objective: A laparoscopic myomectomy (LM) is sometimes repeated because of residual or recurring myomas. The purpose of this study was to examine the characteristics of the cases of repeat LM retrospectively. <br>Materials and methods: The clinical data of 19 women undergoing a repeat LM among 1,707 cases of LM from January 2005 through August 2012 in our hospital were analyzed. All myomas were diagnosed with a MRI, and LM was performed via the pneumoperitoneum method.<br>Results: Ten patients (52.9%) were pretreated with a gonadotropin releasing hormone agonist. The average duration between the first and second LMs was 34.2 months (range: 2 to 76 months). The average number of enucleated myomas was 6.1 (range: 1-22) in the first operation and 7.0 (range: 1-23) in the second procedure. In 12 cases, the myomas were almost completely enucleated; however, small remnants may have remained. In contrast, in the other seven cases, we determined that residual myomas resulted in the repeat LM. The main reasons for the residual myomas were: 1) status several myomas in close proximity; 2) myomas not well visualized; and 3) degenerative myomas, which were difficult to discriminate from normal myometrium.<br>Conclusions: The primary reason for a repeat LM was the unavoidable recurrence of myoma; however, residual myomas were the indication for the reoperation in conditions such as 'myoma complex' and 'degenerative myoma'. In those cases, meticulous surgical technique should reduce the need for a repeat LM.

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