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

• MeSH
• laparoskopie MeSH
• leiomyom chirurgie   MeSH
• lidé MeSH
• nádory dělohy chirurgie   MeSH
• uterus krevní zásobení   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH

Cíl studie: Posoudit vztahy mezi reaktanty akutní fáze u skupiny 40 žen operovaných pro děložní myom laparoskopickou a otevřenou technikou. Typ studie: Prospektivní studie. Metodika: Stanoveny byly koncentrace leukocytů v krvi, C-reaktivního proteinu (CRP), interleukinu 6 (IL-6) a sérového amyloidu A (SAA) v plazmě, resp. séru před operací, 24 hodin a 72 hodin po operaci. Výsledky: Koncentrace leukocytů a IL-6 vykazovaly nejmenší dynamiku nárůstu koncentrací a nejrychlejší úpravu po operaci k výchozím hodnotám. Koncentrace CRP a SAA naopak přetrvávaly zvýšené po operaci. Koncentrace leukocytů v časném pooperačním období nemá výrazné vztahy ke sledovaným reaktantům akutní fáze. Normální koncentrace leukocytů za 72 hodin po operaci byla u 1/3 operovaných žen spojena s pozitivitou přinejmenším jednoho reaktantu akutní fáze a u čtvrtiny byly zvýšeny nejméně dva reaktanty. Typ, tíže a délka zákroku měla vliv na koncentrace CRP, SAA a IL-6. Závěry: SAA vykazuje akutní změny (24 hodin po operaci) obdobně jako CRP a IL-6. Tíži zákroku, délku zátěže a možné riziko 72 hodin po operaci ukazují zejména CRP a SAA (v tomto období jsou již IL-6 a leukocyty sníženy prakticky na předoperační úroveň). Maximální dynamika navýšení byla pozorována u SAA. SAA se jeví jako ukazatel, který by měl být zařazen mezi testy poskytující informaci o možných komplikacích v časném pooperačním období.

Objective: To analyze relations among acute phase reactants in a group of 40 women operated for uterine myom by laparoscopy and open surgery. Design: Prospective study. Methods: Plasma concentrations of C-reactive protein (CRP), serum amyloid A (SAA) and interleukin 6 (IL-6) were measured together with leukocytes in blood before operation, 24 and 72 hours post operation, respectively. Results: Leukocytes and IL-6 displayed minimal response and decreased quickly after operation to preoperative levels. Concentrations of CRP and SAA remained increased after operation. There were no relationships between leukocytes and acute phase reactants. Normal leukocytes 72 hours post operation were found in 1/3 of women with increased at least one acute phase reactants and in 1/4 of women with increased at least two markers. Typ of surgery, surgical stress and length of surgery were related to the concentration of CRP, IL-6 and SAA. Conclusion: Changes in SAA 24 hours after operation are similar to CRP and IL-6. Surgical stress, length of operation and possible risk 72 hours after operation are best predicted by CRP and SAA (at that time IL-6 and leukocytes are practically normal). Maximal increase was found for SAA concentrations. Thus SAA seems to be suitable marker of early postoperative complications.

• MeSH
• finanční podpora výzkumu jako téma MeSH
• fyziologický stres chirurgie   imunologie   MeSH
• gynekologické chirurgické výkony MeSH
• hodnocení rizik MeSH
• leukocytóza krev   MeSH
• lidé MeSH
• mediátory zánětu diagnostické užití   MeSH
• pooperační komplikace prevence a kontrola   MeSH
• prospektivní studie MeSH
• sérový amyloid A diagnostické užití   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví 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

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

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

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

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