Myoma pseudocapsuleを意識した筋腫核出と縫合～Bottomを拾わない～

抄録

Introduction: The myoma pseudocapsule (MPC) is a metaplastic connective tissue formed by the displacement of the normal muscle layer by a uterine myoma; it plays an important role in wound healing throughout the body. However, few studies have specifically addressed the procedures for its preservation in laparoscopic myomectomy(LM). We have devised a procedure, termed as "MPC accurately conserved LM " (Mac-LM), for myoma enucleation and suturing that conserves the MPC.

Patients and Methods: Muscle layer recovery in patients who underwent Mac-LM was evaluated 3 months postoperatively via contrast-enhanced magnetic resonance imaging (MRI).We compared blood loss and suturing time between eight patients with interstitial myoma who underwent Mac-LM and eight patients who underwent conventional LM. Mac-LM was performed in the following manner: (1) A dilute vasopressin solution with indigo carmine was injected into the MPC layer. (2) Enucleation was performed to conserve the stained MPC. (3) After confirming the absence of bleeding from the MPC, a single-layer suture was inserted in the muscle layer alone without lifting the bottom.

Results: MRI of the Mac-LM patients, performed 3 months postoperatively, did not reveal any contrast defects or thinning of the muscle layer. Blood loss was 101 mL and 250 mL, and the suturing time was 13 min and 28 min for the Mac-LM and conventional LM groups, respectively.

Discussion: Staining to visualize the MPC reduced injury during enucleation, while decreasing blood loss. There were no problems with muscle recovery

Conclusions: Mac-LM may be a useful therapeutic procedure for interstitial myoma.