Öz
Aim: To compare the perioperative outcomes between patients who underwent myomectomy during cesarean section and those without myomectomy during cesarean section retrospectively.
Materials and Methods: In our study, a total of 187 patients, including 125 patients who underwent myomectomy (case) during cesarean section and 62 patients who had not undergone myomectomy (control) during cesarean section, were included in our clinic between February 2015- October 2019. Basic demographic characteristics of the patients, gestational week at the time of operation, the mean number of myoma and size, locations of myoma, mean differences between hemoglobin and hematocrit levels postoperatively, mean operation time, need for erythrocyte transfusion, and mean hospitalization time were retrospectively evaluated.
Results: The mean diameter of the myoma in the control group is significantly higher than that of the myomectomy group (5.75 ± 3.71 cm and 4.73 ± 3.76 cm, respectively; p:0.0057). The mean operation time was 82.81 ± 28.69 min. and 70.08 ± 17.89 min. in the myomectomy and control groups, respectively (p: 0.003). There was no statistically significant difference between the two groups in the other parameters (Mean Hb, Htc differences postoperatively, mean hospitalization time, etc.).
Conclusion: Our results support that myomectomy performed during the cesarean section does not increase perioperative morbidity and may be useful when it is performed by experienced surgeons. In addition, myomectomy during cesarean section can decrease the need for secondary surgery due to the myoma.
Anahtar Kelimeler
Kaynakça
- 1. Liu WM, Wang PH, Tang WL, Wang IT, Tzeng CR. Uterine artery ligation for treatment of pregnant women with uterine leiomyomas who are undergoing cesarean section. Fertil Steril 2006; 86: 423-8.
- Vergani P, Locatelli A, Ghidini A, Andreani M, Sala F, Pez- zullo JC. Large uterine leiomyomata and risk of cesarean delivery. Obstet Gynecol 2007; 109: 410-4.
- Klatsky PC, Tran ND, Caughey AB, Fibroids FVY. reproductive outcomes: A systematic literature review from conception to delivery. American Journal of Obstetrics and Gynecology. 2008; 198: 357-66.
- Hortu I, Akdemir A, Şendağ F, Öztekin MK. Uterine rupture in pregnancy after robotic myomectomy. Turk J Obstet Gynecol. 2015; 12: 188-91.
- Lee HJ, Norwitz ER, Shaw J. Contemporary management of fibroids in pregnancy. Rev Obstet Gynecol. 2010; 3: 20-7.
- Turan V, Ergenoglu M, Yeniel O, et al. Assessment of pregnancy outcomes with uterine leiomyomas larger than 10 cm; antepartum and postpartum complications. J Pediatr Adolesc Gynecol. 2010; 23: 57-8.
- Song D, Zhang W, Chames MC, et al. Myomectomy during cesarean delivery. International Journal of Gynecology and Obstetrics. 2013; 121: 208-13.
- Park BJ, Kim YW. Safety of cesarean myomectomy. The Journal of Obstetrics and Gynaecology Research. 2009; 35: 906-11.
- Ramesh Kumar R, Patıl M, Sa S. The utility of cesarean myomectomy as a safe procedure. Journal of Clinical and Diagnostic Research. 2014; 8: 0005-0008.
- Lee JH, Cho DH. Myomectomy using purse-string suture during cesarean section. Arch Gynecol Obstet 2011; 283: 35-7.
- Hatırnaz Ş, Güler O, Başaranoğlu S, Tokgöz C, Kılıç GS. Endometrial myomectomy: A novel surgical method during cesarean section. The Journal of Maternal-Fetal & Neonatal Medicine. 2018; 31: 433-8.
- Song D, Zhang W, Chames MC, Guo J. Myomectomy during cesarean delivery. International Journal of Gynecology & Obstetrics. 2013; 121: 208-13.
- Tinelli A, Malvasi A, Mynbaev OA, et al. The surgical outcome of intracapsular cesarean myomectomy: a match control study. J Matern Fetal Neonatal Med. 2014; 27: 66–71.
- Ma CP, Juan YC, Wang ID, Chen CH, Liu WM, Jeng CJ. A huge leiomyoma subjected to a myomectomy during a cesarean section. Taiwan J Obstet Gynecol 2010; 49: 220-1.
- Kaymak O, Ustunyurt E, Okyay RE, et al. Myomectomy during cesarean section. Int J Gynecol Obstet. 2005; 89: 90-3.
- Tian J, Hu W. Cervical leiomyomas in pregnancy: Report of 17 cases. Aust N Z J Obstet. Gynaecol. 2012; 52: 258-61.
- Kwon D H, Song Ji E, Yoon K R, Lee K Y The safety of cesarean myomectomy in women with large myomas. Obstet Gynecol Science Sep 2014; 57: 367–72.
- Ehigiegba AE, Ande AB, Ojobo SI. Myomectomy during cesarean section. Int. J. Gynecol. Obstet. 2001; 75: 21-5.
- Sapmaz E, Celik H, Altungul A. Bilateral ascending uterine artery ligation vs. tourniquet use for hemostasis in cesarean myomectomy. A comparison. J Reprod Med. 2003; 48: 950-4.
- Cobellis L, Florio P, Stradella L, et al. Electro-cautery of myomas during caesarean section-two case reports. Eur J Obstet Gynecol Reprod Biol. 2002; 102: 98-9.
- Roman AS, Tabsh KM. Myomectomy at time of cesarean delivery: a retrospective cohort study. BMC Pregnancy Childbirth. 2004; 4: 14.
- Li H, Du J, Jin L, Shi Z, Liu M. Myomectomy during cesarean section. Acta Obstet Gynecol Scand 2009; 88: 183-6.
Öz
Amaç: Sezaryen sırasında miyomektomi yapılan (olgu) ve miyomektomi yapılmayan (kontrol) hastalar arasındaki perioperatif sonuçları retrospektif olarak kıyaslamak.
Gereç ve Yöntem: Çalışmamıza kliniğimizde Şubat 2015 – Ekim 2019 tarihleri arasındaki sezaryen sırasında miyomektomi yapılan (olgu) 125 hasta ve sezaryen esnasında miyomektomi yapılmayan (kontrol) 62 hasta olmak üzere toplam 187 hasta dahil edildi. Hastaların temel demografik özellikleri, gebelik haftaları, miyom sayı ve ortalama çapları, yerleşim yerleri, postoperatif hemoglobin ve hematokrit değişiklikleri, operasyon süreleri, eritrosit transfüzyon ihtiyaçları ve hastanede kalış süreleri kıyaslanmıştır.
Bulgular: Her iki gruptaki hastalar karşılaştırıldığında miyomektomi yapılmayan gruptaki hastaların ortalama miyom çapları daha yüksek olarak bulundu (miyomektomi yapılanlarda: 4,73 ±3,76 cm, miyomektomi yapılmayanlarda: 5,75 ±3,71 cm; p:0,0057). Operasyon süresi ise miyomektomi yapılan grupta 82,81 ±28,69 dk. iken miyomektomi yapılmayan grupta 70.08 ±17.89 dk. olarak bulundu (p: 0,003). İki grup arasında diğer parametrelerde (ortalama hemoglobin, hematokrit değişiklikleri, hastanede kalış süresi, vb.) istatistiksel olarak anlamlı fark saptanmadı.
Sonuç: Sezaryen operasyonu sırasında gerçekleştirilen miyomektominin perioperatif morbiditeyi arttırmadığı ve uygun hasta grubunda tecrübeli ekip tarafından yapıldığında hastanın ikincil bir cerrahi operasyona ihtiyacının azaltması açısından faydalı bir uygulama olabileceği gösterilmiştir
Anahtar Kelimeler
Kaynakça
- 1. Liu WM, Wang PH, Tang WL, Wang IT, Tzeng CR. Uterine artery ligation for treatment of pregnant women with uterine leiomyomas who are undergoing cesarean section. Fertil Steril 2006; 86: 423-8.
- Vergani P, Locatelli A, Ghidini A, Andreani M, Sala F, Pez- zullo JC. Large uterine leiomyomata and risk of cesarean delivery. Obstet Gynecol 2007; 109: 410-4.
- Klatsky PC, Tran ND, Caughey AB, Fibroids FVY. reproductive outcomes: A systematic literature review from conception to delivery. American Journal of Obstetrics and Gynecology. 2008; 198: 357-66.
- Hortu I, Akdemir A, Şendağ F, Öztekin MK. Uterine rupture in pregnancy after robotic myomectomy. Turk J Obstet Gynecol. 2015; 12: 188-91.
- Lee HJ, Norwitz ER, Shaw J. Contemporary management of fibroids in pregnancy. Rev Obstet Gynecol. 2010; 3: 20-7.
- Turan V, Ergenoglu M, Yeniel O, et al. Assessment of pregnancy outcomes with uterine leiomyomas larger than 10 cm; antepartum and postpartum complications. J Pediatr Adolesc Gynecol. 2010; 23: 57-8.
- Song D, Zhang W, Chames MC, et al. Myomectomy during cesarean delivery. International Journal of Gynecology and Obstetrics. 2013; 121: 208-13.
- Park BJ, Kim YW. Safety of cesarean myomectomy. The Journal of Obstetrics and Gynaecology Research. 2009; 35: 906-11.
- Ramesh Kumar R, Patıl M, Sa S. The utility of cesarean myomectomy as a safe procedure. Journal of Clinical and Diagnostic Research. 2014; 8: 0005-0008.
- Lee JH, Cho DH. Myomectomy using purse-string suture during cesarean section. Arch Gynecol Obstet 2011; 283: 35-7.
- Hatırnaz Ş, Güler O, Başaranoğlu S, Tokgöz C, Kılıç GS. Endometrial myomectomy: A novel surgical method during cesarean section. The Journal of Maternal-Fetal & Neonatal Medicine. 2018; 31: 433-8.
- Song D, Zhang W, Chames MC, Guo J. Myomectomy during cesarean delivery. International Journal of Gynecology & Obstetrics. 2013; 121: 208-13.
- Tinelli A, Malvasi A, Mynbaev OA, et al. The surgical outcome of intracapsular cesarean myomectomy: a match control study. J Matern Fetal Neonatal Med. 2014; 27: 66–71.
- Ma CP, Juan YC, Wang ID, Chen CH, Liu WM, Jeng CJ. A huge leiomyoma subjected to a myomectomy during a cesarean section. Taiwan J Obstet Gynecol 2010; 49: 220-1.
- Kaymak O, Ustunyurt E, Okyay RE, et al. Myomectomy during cesarean section. Int J Gynecol Obstet. 2005; 89: 90-3.
- Tian J, Hu W. Cervical leiomyomas in pregnancy: Report of 17 cases. Aust N Z J Obstet. Gynaecol. 2012; 52: 258-61.
- Kwon D H, Song Ji E, Yoon K R, Lee K Y The safety of cesarean myomectomy in women with large myomas. Obstet Gynecol Science Sep 2014; 57: 367–72.
- Ehigiegba AE, Ande AB, Ojobo SI. Myomectomy during cesarean section. Int. J. Gynecol. Obstet. 2001; 75: 21-5.
- Sapmaz E, Celik H, Altungul A. Bilateral ascending uterine artery ligation vs. tourniquet use for hemostasis in cesarean myomectomy. A comparison. J Reprod Med. 2003; 48: 950-4.
- Cobellis L, Florio P, Stradella L, et al. Electro-cautery of myomas during caesarean section-two case reports. Eur J Obstet Gynecol Reprod Biol. 2002; 102: 98-9.
- Roman AS, Tabsh KM. Myomectomy at time of cesarean delivery: a retrospective cohort study. BMC Pregnancy Childbirth. 2004; 4: 14.
- Li H, Du J, Jin L, Shi Z, Liu M. Myomectomy during cesarean section. Acta Obstet Gynecol Scand 2009; 88: 183-6.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Aralık 2020 |
| Gönderilme Tarihi | 8 Haziran 2020 |
| Yayımlandığı Sayı | Yıl 2020 |