腹腔鏡下子宮筋腫核出術の術中出血量の予測についての検討

抄録

Objective: Laparoscopic myomectomy (LM) is one of the most difficult surgical techniques. To complete LM safely, controlling intraoperative bleeding is important. In this study, we retrospectively investigated the relationships between size and location of uterine myomas and the amount of intraoperative blood loss during LM at our hospital.

Methods: 219 patients who underwent LM at our hospital during the 4-year period from January 2017 to December 2020 were enrolled. The patients were classified into 137 intramuscular myoma group and 82 submucosal myoma group according to the location. We examined the maximum myoma diameter and blood loss, and the blood loss with and without preoperative GnRH analogue treatment.

Results: The maximum myoma diameter was positively correlated with the blood loss, but the number of myomas was not. The maximum myoma diameter tends to cause abnormal blood loss (bleed more than 500 ml) was more than 8.9 cm in the intramuscular myoma group, and more than 14.1 cm in the submucosal myoma group. Furthermore, there was a tendency to the preoperative GnRH analogue group to bleed approximately 40 ml more than the non-treated group compared by the same maximum myoma diameter.

Conclusion: It was not the number of myomas but the maximum myoma diameter that relates to the amount of blood loss in LM. Thus, if abnormal bleeding is predicted based on the maximum myoma diameter before surgery, explain the risks to the patient and also share the risks between operators may help to ensure safer LM.