BACKGROUND: We assessed the results and impact of blockage of utero-ovarian anastomoses (UOA) on clinical outcome in women treated by laparoscopic uterine artery occlusion for uterine fibroids. METHODS: Between 2004 and 2005, we prospectively analyzed the clinical data for 23 laparoscopic uterine artery occlusion cases combined with blockage of utero-ovarian anastomoses (Group A) and 67 laparoscopic uterine artery occlusion cases alone (Group B). RESULTS: Of these 23 patients with UOA (mean age, 36.7+/-2.8 years), 10 patients (43.4%) had anastomoses bilaterally and 13 patients (56.6%) had unilateral anastomoses. Mean fibroid size reduction after LUAO and anastomoses blockage was 32.5% from baseline (P<0.001). In patients with LUAO, the mean DF size after surgery was estimated at 38.7+/-19.2 mm, which translated to a mean fibroid size reduction of 30.6% from baseline (P<0.001). No case of clinical failure or recurrence was found in Group A patients with UOA (mean follow-up, 15.6 months), who were treated with combined surgery. At a mean clinical follow-up of 18.2 months (Group B), 6 patients (8.9%) elected to undergo further surgical intervention for clinical failure and recurrence, including 4 myomectomies and 2 hysterectomies. The statistical difference between groups was not significant (P=0.33). CONCLUSION: Laparoscopic blockage of utero-ovarian anastomoses combined with uterine artery occlusion is a safe, feasible surgical procedure in women with symptomatic fibroids. Combining the uterine artery occlusion and blockage of UO anastomoses may be a useful procedure for the decreasing rate of clinical failure and recurrence. This premise should be confirmed in a larger prospective multicenter study.
Závěrečná zpráva o řešení grantu Interní grantové agentury MZ ČR
Přeruš. str. : il., tab. ; 30 cm
The rational assessment of the place of the laparoscopic dissection of uterine vessels in the management of the uterine fibroids. The assessement of import a new minimally invasive method for the reproductive potential ,social and economic quality of woman life.
Racionální zhodnocení místa laparoskopické disekce děložních cév v managementu děložních myomů. Zhodnocení přínosu nové minimálně invazivní metody s ohledem na reprodukční potenciál,sociální a ekonomické faktory života ženy .
- MeSH
- fertilita MeSH
- laparoskopie MeSH
- mikrodisekce MeSH
- miniinvazivní chirurgické výkony MeSH
- myom terapie MeSH
- uterus MeSH
- výkony cévní chirurgie MeSH
- Konspekt
- Gynekologie. Porodnictví
- NLK Obory
- gynekologie a porodnictví
- angiologie
- NLK Publikační typ
- závěrečné zprávy o řešení grantu IGA MZ ČR
OBJECTIVE: To determine the differences in inflammatory response and clinical outcome of current clinical practice in women undergoing laparoscopic myomectomy (LM) and abdominal myomectomy (AM) for symptomatic fibroid. METHODS: A total of 36 women entered the study between October 2004 to June 2005 at the Department of Gynecology and Obstetrics and the Endoscopy Training Center at the Baby Friendly Hospital in Kladno, Czech Republic, based upon an ultrasonographic assessment size of dominant fibroid (DM) before surgery. All women were allocated to one of 2 groups: group 1 (n=17), DM <6 cm and treated with LM, and group 2 (n=19) DM > or =6 cm, treated with open myomectomy. Surgical characteristics, hospital stay and complications were analyzed. Blood samples for assay of the acute phase reactants and markers of tissue trauma [C-reactive protein (CRP), interleukin-6 (IL-6), serum amyloid A (SAA), white blood cell count (WBC) and creatine kinase (CK)] were taken preoperatively and on the first and third postoperative day. RESULTS: The difference between the groups in the mean size of DM was statistically significant (4.8 cm in group 1 versus 6.9 cm in group 2, p<0.05). Statistically, significant differences were found between the compared groups in intra-operative blood loss (p<0.05) and length of hospital stay (p<0.001). No complication was reported after LM. There were significantly higher levels of CRP, IL-6, SAA, WBC and CK in both groups after surgery. Increased levels of IL-6, WBC and CK were greatest on the first postoperative day in both groups, and increased levels of CRP and SAA on the third postoperative day in the open group. The serum CRP, IL-6, SAA, WBC, CK and the fall in hemoglobin were statistically different between the 2 groups. CONCLUSION: Compared with open myomectomy, LM was associated with a less intensive inflammatory response and a more favorable clinical outcome.
- MeSH
- C-reaktivní protein analýza MeSH
- časové faktory MeSH
- dospělí MeSH
- interleukin-6 krev MeSH
- interpretace statistických dat MeSH
- kreatinkinasa krev MeSH
- laparoskopie * MeSH
- laparotomie MeSH
- leiomyom * chirurgie ultrasonografie MeSH
- lidé MeSH
- nádory dělohy * chirurgie ultrasonografie MeSH
- prospektivní studie MeSH
- sérový amyloid A analýza MeSH
- výsledek terapie MeSH
- zánět diagnóza etiologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- hodnotící studie MeSH
- klinické zkoušky kontrolované MeSH
- srovnávací studie MeSH
OBJECTIVE: To assess pregnancy outcomes and deliveries after laparoscopic uterine artery transsection (LTUV) in symptomatic women with fibroids. SETTING: Department of Obstetrics and Gynecology, Endoscopic Training Center, Baby Friendly Hospital, Kladno, Czech Republic. DESIGN: One hundred and fifty three patients underwent laparoscopic transsection of uterine vessels during a 4-year period. RESULTS: Nine of the 21 women desiring pregnancy conceived spontaneously and one after anovulation treatment. The average age of the women was 32.4 years, and the range was 26-39 years. Two women had vaginal delivery at term and one delivered vaginally at 31 weeks secondary to premature preterm rupture of membrane (PROM). Four others delivered at term by cesarean section. One woman with placenta previa was delivered by cesarean section 3 weeks before term. Mean birth weight was 3199 g (range 1710-3910 g). One spontaneous abortion was reported in the first trimester of pregnancy. One case of undesired pregnancy occurred. An extrauterine pregnancy was reported in this woman. CONCLUSION: LTUV is a minimally invasive operative procedure, that preserves the uterus and ovarian blood supply and allows for the achievement of pregnancy in women with symptomatic fibroids. Fetal growth and umbilical Doppler findings remained normal in all cases. An increased risk for preterm delivery and cesarean section was found in this small series.
- MeSH
- arterie MeSH
- dospělí MeSH
- laparoskopie MeSH
- leiomyom krevní zásobení terapie MeSH
- lidé MeSH
- nádory dělohy krevní zásobení terapie MeSH
- následné studie MeSH
- pilotní projekty MeSH
- porod v termínu MeSH
- retrospektivní studie MeSH
- těhotenství MeSH
- terapeutická embolizace metody MeSH
- výsledek těhotenství MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- multicentrická studie MeSH
AIM: To determine the frequency and severity of complications and the recurrence of fibroids as a result of laparoscopic occlusion of the uterine artery (LOUA) in women with symptomatic fibroids. METHODS: One hundred and fourteen women with symptomatic fibroids were treated using ultrasonically activated shears, clips or electrosurgery. A retrospective evaluation of the complications and recurrence rate was carried out. For each patient, the analysis took place at least 3 months after the procedure was performed. Each complication was categorized using the complication classifications developed by the Czech Society of Gynecologic Endoscopy and a modified set of the classifications of the American College of Obstetricians and Gynecologists. All adverse events that occurred during the follow-up period were included, in addition to those that occurred after the 3 months minimum interval. RESULTS: A total of eight women (7.1%, 95% confidence intervals [CI], 3.3-14.4) experienced complications; one of these women had two complications, resulting in a total of nine adverse events. There were no intraoperative complications and no permanent injuries. Two women required supracervical hysterectomy and myomectomy, respectively, as a result of fibroid necrosis. One patient had an undiagnosed endometrial stromal sarcoma after 12 months of LOUA. The rate of fibroid recurrence was 9.0% (10 patients). The recurrence-free survival interval rate (no clinical failure, no recurrence) at 23.6 months (median) follow-up was 88.3% (CI 84.9-93.5). CONCLUSION: The rate of complications and fibroid recurrence was low in patients undergoing LOUA.
- MeSH
- arterie chirurgie MeSH
- dospělí MeSH
- financování organizované MeSH
- laparoskopie škodlivé účinky MeSH
- leiomyom chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lokální recidiva nádoru MeSH
- nádory dělohy chirurgie MeSH
- pooperační komplikace MeSH
- retrospektivní studie MeSH
- uterus chirurgie krevní zásobení MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- klinické zkoušky MeSH
BACKGROUND: We assessed the results and impact of lateral uterine artery dissection on clinical outcome following laparoscopic myomectomy. METHODS: We retrospectively analyzed the clinical data for 27 laparoscopic myomectomy cases (Group I) and 54 laparoscopic myomectomy cases combined with lateral uterine artery dissection (Group II) between January 2001 and August 2004 in one center. Only 81 patients who had dominant fibroids between 4 cm and 10 cm in diameter were included in the study. We assessed the clinical outcomes: perioperative blood loss, operating time, hospital stay, complications, hemoglobin decrease, inflammatory response, and tissue markers (C-reactive protein, white blood cells, creatinine kinase) changes. RESULTS: The mean operating time was 70.37 minutes in group I and 78.61 minutes in group II. The mean length of hospital stay was 2.7 days versus 2.2 days, respectively (P>0.05). The difference in intraoperative blood loss was 70.1 mL (147.7 mL vs 77.3 mL, Group I) and 33.9 mL (105 mL vs 71.1 mL, Group II); estimated postoperative blood loss was statistically significant (P<0.001, P<0.05, respectively). Group 2 demonstrated a less intense stress response in C-reactive protein (P<0.001) and white blood cell count (P<0.05). CONCLUSION: The dissection of the uterine artery in laparoscopic myomectomy is a feasible operative procedure with a low rate of complications. The procedure reduced perioperative blood loss and resulted in significant improvement in fibroid-related symptoms.
- MeSH
- arterie chirurgie MeSH
- délka pobytu MeSH
- dospělí MeSH
- financování organizované MeSH
- krvácení při operaci statistika a číselné údaje MeSH
- laparoskopie MeSH
- leiomyom chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory dělohy chirurgie MeSH
- retrospektivní studie MeSH
- uterus krevní zásobení MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
BACKGROUND: This study aimed to assess laparoscopic dissection of uterine vessels (LDUV) for symptomatic fibroids in women. METHODS: A total of 69 women entered the study between March 2000 and June 2003. In this case series, 68 consecutive women underwent LDUV using ultrasonically activated sheers or electrosurgery for the treatment of fibroids over 3 years (median follow-up period, 14.5 months). Ultrasound or magnetic resonance imaging was carried out 3, 6, 12, 24, and 36 months after treatment. The tissue markers, gonadotropin, and estrogen levels were studied postoperatively. RESULTS: Almost all the patients (98.5%) had a successful LDUV with a low rate (7.3%) of postoperative complications. The time of surgery ranged from 15 to 50 min (mean, 30.8 min). The blood loss was minimal (mean, 14.7 ml), and the hospital stay was 2.4 days. Symptom improvement (menorrhagia or dysmenorrhoea) was 93.2%, and the average reduction in the dominant myoma was 57.8% during a follow-up period longer than 12 months. All the patients with anemia had normal red cell counts after 3 months. CONCLUSIONS: Uterine volume and the dominant fibroid were significantly reduced and symptoms were improved by LDUV. The laparoscopic procedure is associated with insignificant tissue damage and normal gonadotropin and estrogen levels.
- MeSH
- časové faktory MeSH
- dospělí MeSH
- laparoskopie * MeSH
- leiomyom * chirurgie krevní zásobení MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory dělohy * chirurgie krevní zásobení MeSH
- následné studie MeSH
- prospektivní studie MeSH
- výkony cévní chirurgie metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
Závěrečná zpráva o řešení grantu Interní grantové agentury MZ ČR
2 sv. : tab., grafy ; 32 cm
The objective assessment of the laparoscopy-assisted hysterectomy for reducing peroperative morbidity and shortening recovery.Determinantion of criteria and indications for the individual alternative hysterectomy procedures. The assessment of import of laparoscopy in staging the endometrial cancer.
Objektivní zhodnocení přínosu laparoskopické hysterektomie ke snížení perioperační morbidity a zkrácení rekonvalescence.Stanovení kriterií a indikací k jednotlivým přístupům k hysterektomii. Zhodnocení přínosu laparoskopie ke stagingu karcinomu endometria.
- MeSH
- fyziologický stres analýza MeSH
- hysterektomie vaginální MeSH
- laparoskopie metody MeSH
- perioperační péče MeSH
- pooperační péče MeSH
- prospektivní studie MeSH
- Konspekt
- Gynekologie. Porodnictví
- NLK Obory
- gynekologie a porodnictví
- NLK Publikační typ
- závěrečné zprávy o řešení grantu IGA MZ ČR
Závěrečná zpráva o řešení grantu Interní grantové agentury MZ ČR
36 l. : il. ; 32 cm + 3 volné přílohy
Měření celkového množství tělesných tekutin pomocí stanovení celotělové bioelektrické impedance. XXX XXX XXX
