BACKGROUND Hypermenorrhea is characterized by excessive menstrual bleeding that causes severe anemia and interferes with everyday life.This condition can restrict women’s social activities and decrease their quality ...BACKGROUND Hypermenorrhea is characterized by excessive menstrual bleeding that causes severe anemia and interferes with everyday life.This condition can restrict women’s social activities and decrease their quality of life.Microwave endometrial ablation(MEA)using a 2.45-GHz energy source is a minimally invasive alternative to conventional hysterectomy for treating hypermenorrhea that is resistant to conservative treatment,triggered by systemic disease or medications,or caused by uterine myomas and fibrosis.The popularity of MEA has increased worldwide.Although MEA can safely and effectively treat submucous myomas,some patients may still experience recurrent hypermenorrhea postoperatively and may require additional treatment.AIM To investigate the efficacy of MEA combined with transcervical resection(TCR).METHODS Participants underwent cervical and endometrial evaluations.Magnetic resonance imaging and hysteroscopy were performed to evaluate the size and location of the myomas.TCR was performed before MEA using a hystero-resectoscope.MEA was performed using transabdominal ultrasound.The variables included operation time,number of ablation cycles,length of hospital stay,and visual analog scale cores for hypermenorrhea,dysmenorrhea,and treatment satisfaction at 3 and 6 mo postoperatively.The postoperative incidence of amenorrhea,changes in hemoglobin concentrations,and MEA-related complications were evaluated.RESULTS A total of 34 women underwent a combination of MEA and TCR during the study period.Two patients were excluded from the study as their histopathological tests identified uterine malignancies(uterine sarcoma and endometrial cancer).The 32 eligible women(6 nulliparous,26 multiparous)had a mean age of 45.2±4.3 years(range:36–52 years).Patients reported very severe hypermenorrhea(10/10 points on the visual analog scale)before the procedure.However,after the procedure,the hypermenorrhea scores decreased to 1.2±1.3 and 0.9±1.3 at 3 and 6 mo,respectively(P<0.001).The mean follow-up duration was 33.8±16.8 mo.Although 10 women(31.3%)developed amenorrhea during this period,none experienced a recurrence of hypermenorrhea.No surgical complications were observed.CONCLUSION Reducing the size of uterine myomas by combining MEA and TCR can safely and effectively treat hypermenorrhea in patients with submucous myomas.展开更多
Introduction: Uterine fibroid is a mixed mesenchymal tumor, developing from smooth muscle cells of the myometrium, separated by connective tissue. The majority of fibroids are asymptomatic and do not require any inter...Introduction: Uterine fibroid is a mixed mesenchymal tumor, developing from smooth muscle cells of the myometrium, separated by connective tissue. The majority of fibroids are asymptomatic and do not require any intervention or other exploratory measures. However, in some cases fibroids are symptomatic, their treatment should aim to improve symptoms and quality of life. Objectives: Describe the epidemiological-clinical aspects of uterine fibroids in the gynecology and obstetrics department of the reference health center of commune VI of the Bamako district. Methodology: This was a retrospective descriptive study carried out over a period of one year. It concerns all patients seen in consultation in the gynecology and obstetrics department of the reference health center of commune VI. Results: during the study period, the uterine fibroid frequency was 1.80%. During this same period, fibroids represented 5.59% of gyneco-obstetric pathologies operated on in the department. The 30 - 45 year old age group was the most represented with a frequency of 75.63%. The average age was 36.87 years ± 6.2 years with extremes of 25 and 63 years. Married women were the most represented 97.48%. The vast majority of our patients 95.8% were not postmenopausal. The multigravidas were the most represented, i.e. 37.50% with a large part of the pauciparous 41.29%. In our patients, 96.64% had a clinical symptom on their fibroid with the main reason for consultation being the sensation of a pelvic mass in 97.48%. We recorded three cases of infertility as associated factors. Ultrasound was performed in all patients. The location of the myxomatous nuclei was subserosal in the majority in 42.86% and with multiple nodules in 84.85% of cases. The main indication for myomectomy was the failure of medical treatment in 86.49% of cases. Surgical treatment was mainly a myomectomy 93.30%, a hysterectomy was indicated in 6.70%. No cases of death were recorded. Conclusion: Uterine fibroid is a gynecological pathology that exists in our department;its frequency is estimated at 5.59%. For better management of fibroids, it is necessary to have a good knowledge of the factors favoring the occurrence of uterine fibroids, their growth and the symptoms to prevent the appearance of it or even at best to operate. This prevention must be a concern for public health because fibromatous pathology is frequent, costly and hampers quality of life.展开更多
BACKGROUND Microwave endometrial ablation(MEA)is a minimally invasive treatment method for heavy menstrual bleeding.However,additional treatment is often required after recurrence of uterine myomas treated with MEA.Ad...BACKGROUND Microwave endometrial ablation(MEA)is a minimally invasive treatment method for heavy menstrual bleeding.However,additional treatment is often required after recurrence of uterine myomas treated with MEA.Additionally,because this treatment ablates the endometrium,it is not indicated for patients planning to become pregnant.To overcome these issues,we devised a method for ultrasound-guided microwave ablation of uterine myoma feeder vessels.We report three patients successfully treated for heavy menstrual bleeding,secondary to uterine myoma,using our novel method.CASE SUMMARY All patients had a favorable postoperative course,were discharged within 4 h,and experienced no complications.Further,no postoperative recurrence of heavy menstrual bleeding was noted.Our method also reduced the myoma’s maximum diameter.CONCLUSION This method does not ablate the endometrium,suggesting its potential appli-cation in patients planning to become pregnant.展开更多
Background：The relationship between intramural myomas and fertility remains unclear.The main debate rests on whether cavity-distorting intramural lnyomas （CDMs） adversely affect fertility more than non-CDMs.We aime...Background：The relationship between intramural myomas and fertility remains unclear.The main debate rests on whether cavity-distorting intramural lnyomas （CDMs） adversely affect fertility more than non-CDMs.We aimed to compare the effects ofenucleating non-CDMs and CDMs on fertility improvement in females with unexplained infertility.Methods：We prospectively recruited 83 women undergoing myomectomy for unexplained infertility with intramural myomas between June 2008 and November 2012 and classified them into non-CDMs group （n =45） and CDMs group （n =38）.We then compared postoperative infertility rates,spontaneous pregnancy rates,pregnancy outcomes,live birth rates,and obstetric complications.For continuous variables,we calculated the mean ± standard deviation,median and interquartile range,and analyzed the data using Student＇s t-test and the Mann-Whitney U-test.For categorical variables,the Pearson＇s Chi-square test,the continuity correction test,and Fisher＇s exact test were used.Results：Patients＇ demographics and myoma characteristics were comparable between the two groups.The overall spontaneous pregnancy rate increased from 0% to 68.42% following myomectomy.The postoperative infertility rate was significantly higher in the non-CDMs group than that in the CDMs group （50.00% vs.23.53%,t =5.579,P =0.018）,whereas the postoperative spontaneous pregnancy rate was significantly lower in the non-CDMs group than that in the CDMs group （47.62% vs.70.59%,t 4.067,P =0.044）.Compared with the enucleation ofnon-CDM,the enucleation of CDM patients was a protective factor for the fertility restoration （risk ratio [RR] =3.717,95% confidence interval [CI]：1.284-10.753,P =0.015）,although postoperative fertility restoration declined with age （RR =1.141,95% CI：1.005-1.295,P =0.041）.Conclusions：Intramural myomas are associated with impaired fertility.Women experiencing unexplained infertility,and possessing intramural myomas,have a better chance of conception following myomectomy,and these benefits are more obvious for younger patients and patients with CDM.展开更多
Aims: Infertility is a major problem in our current societies and the Fertilia medical clinic in Bamako is a center for medical assistance in procreation (MAP) where there is an increasingly growing demand for ultraso...Aims: Infertility is a major problem in our current societies and the Fertilia medical clinic in Bamako is a center for medical assistance in procreation (MAP) where there is an increasingly growing demand for ultrasound. The objective of our study was to investigate the ultrasound causes likely to prevent the occurrence of pregnancy in a group of infertile and subfertile women. Subjects and Methods: This was a 5-year cross-sectional and prospective study, between January 2017 and January 2022, which involved 250 women wishing to become pregnant (infertile or subfertile), who came for pelvic ultrasound or follicular monitoring and who agreed to participate in our study. The parameters used were ultrasound reports including uterine, ovarian and tubal pathologies. It should be noted that in some cases no ultrasound cause of infertility was found. Data were entered and analyzed in SPSS. Results: 250 women were recruited into our. The average age was 32 years with extremes ranging from 17 to 51 years. 179 patients or 71.6% were between 17 and 35 years old. 139 patients or 55.6% had secondary infertility against 44.4% primary infertility. 202 patients or 80.8% had at least one ultrasound lesion and 48 patients or 19.2% had no significant ultrasound abnormality. The most represented ultrasound lesions were of uterine origin with 72.20%, 23.7% ovarian lesions and 04% tubal lesions. Uterine lesions were dominated by myomas, adenomyosis, endometrial polyps, uterine malformations and synechiae. As for ovarian lesions we noted cysts, polycystic ovary syndrome (PCOS), ovarian endometriosis, non-follicular ovaries and tubal ultrasound lesions showed unilateral or bilateral hydrosalpinx. Conclusion: In our study, ultrasound was an invaluable contribution to the diagnosis of the causes likely to explain subfertility and infertility in our respondents. She highlighted uterine, ovarian and tubal lesions, some of which could be corrected and pregnancies ensued.展开更多
BACKGROUND Hysteromyoma is not a rare tumor among pregnant women.During pregnancy,the symptoms caused by hysteromyoma can be improved through conservative treatment in most cases.However,in order to ensure the safety ...BACKGROUND Hysteromyoma is not a rare tumor among pregnant women.During pregnancy,the symptoms caused by hysteromyoma can be improved through conservative treatment in most cases.However,in order to ensure the safety of mothers and children,surgeries are necessary in some special cases.CASE SUMMARY We report a case of pregnancy complicated with hysteromyoma red degeneration.The patient had peritonitis after sudden abdominal pain during the 20th week of pregnancy.Laparoscopic exploration suggested rupture and bleeding of hysteromyoma,which were improved after drainage and an anti-inflammatory treatment.A cesarean section was performed after full term.This case shows the complications of rupture after red degeneration of hysteromyoma during pregnancy.CONCLUSION We should be alert to rupture of hysteromyoma during pregnancy,and active laparoscopic exploration is essential to improve the prognosis of such patients.展开更多
BACKGROUND In the presence of a large uterus,total laparoscopic hysterectomy(TLH),always requires morcellation to allow removal of the tissues from the abdominal cavity.However,uncontained morcellation has been scruti...BACKGROUND In the presence of a large uterus,total laparoscopic hysterectomy(TLH),always requires morcellation to allow removal of the tissues from the abdominal cavity.However,uncontained morcellation has been scrutinized because of the possible spread of occult leiomyosarcoma.Therefore,in-bag extracorporeal morcellation has been developed.However,tissue containment and extraction are extremely challenging,especially when considering the increasing uterine size to be removed through minimally invasive surgery.CASE SUMMARY Herein,we describe a novel technique for extracorporeal intrauterine morcellation using the uterus outermost layer as a bag to achieve tissue extraction of very large uteri with suspected occult leiomyosarcoma after TLH.The study enrolled patients who were planned for TLH for large uteri(weight>500 g).TLH was performed following the procedure reported in our previous studies.The novel technique has been described step-by-step in a video,which representatively describes the preoperative imaging and morcellation procedure of three very large uteri weighing 1500 g,1700 g,and 3700 g,respectively.The procedures were performed without any complications.The patients had an uneventful postoperative course,and in all cases,the pathology was benign leiomyoma.CONCLUSION Extracorporeal intrauterine morcellation using the uterus outmost layer as a bag was found to be a feasible technique that allows a careful diagnosis and safe removal of suspected occult malignancies.The technique herein presented may be adopted in surgical practice,by adding it to the other available techniques of contained morcellation.It may represent a valid and feasible alternative,especially useful in cases of very large uteri exceeding the capacity of specimen retrieval bags.展开更多
子宫肌瘤是妇科最常见的良性肿瘤,子宫肌瘤合并妊娠占肌瘤患者的0.5%-1%,占妊娠者的0.3%-0.5%,黏膜下子宫肌瘤占肌瘤总数10%-15%。宫腔镜下子宫肌瘤电切术（transcervical resection of myoma,TCRM）是目前解决黏膜下肌瘤的较为理想的...子宫肌瘤是妇科最常见的良性肿瘤,子宫肌瘤合并妊娠占肌瘤患者的0.5%-1%,占妊娠者的0.3%-0.5%,黏膜下子宫肌瘤占肌瘤总数10%-15%。宫腔镜下子宫肌瘤电切术（transcervical resection of myoma,TCRM）是目前解决黏膜下肌瘤的较为理想的方法。本研究就黏膜下子宫肌瘤行TCRM术后对妊娠的影响进行临床分析。展开更多
Arterial embolization of myomas (AEM) is an established option for the conservative treatment of uterine leio-myomas;it treats all present uterine nodules at once, is less invasive than other procedures and effective ...Arterial embolization of myomas (AEM) is an established option for the conservative treatment of uterine leio-myomas;it treats all present uterine nodules at once, is less invasive than other procedures and effective in controlling symptoms, and does not require long term hospitalizations. Nevertheless, the potential impact on endometrial morphological and functional outcomes after the procedure is still controversial based on reports of endometritis or eventual transient ischemia. This study evaluated endometrial reorganization in uterine leiomyoma patients, before and after AEM, through gene expression analyses of extracellular matrix and cytokines genes in theendometrial tissue. Eight patients with leiomyomas were evaluated before AEM and 6 months after. The examinations included transvaginal pelvic ultrasonography, dosing of the follicle-stimulating hormone, and endometrial biopsy during the second phase of the menstrual cycle. RNA was extracted from endometrial samples, cDNA was synthesized, and applied on PCR arrayTM plates to evaluate the expression of extracellular matrix (ECM) genes and cytokines and their receptors’ genes (CYT). The ECM overexpressed genes were MMP (1, 3, 10, 11, and 14), CTGF1, ICAM1, TBHS1, ITGA2, ITGA3, ITGB3, COL7A1, COL12A, SPP1, and TNC;ADAMTS8 was underexpressed. The CYT overexpressed genes were SPP1, BCL6, CXCL12, IL-8, and CEBPB;CXCL13 and CCL21 were underexpressed. The ECM results showed overexpression of proteases that are responsible for dysfunctions in the ECM, and of genes responsible for adhesion and membrane components. The CYT results showed overexpression of chemokines responsible for endometrial repair, and underexpression of cytokines involved in inflammatory processes in the endometrial tissue. AEM treatment did not negatively affect the endometrial function at 6 months after embolization. This study broadens the knowledge about using a procedure that is relevant to the treatment of leiomyomas and contributes to the establishment of future guidelines for the decision making process for physicians and patients.展开更多
BACKGROUND Uterine myomas are the most common benign gynecological soft tissue tumors in women but polycythemia associated with these tumors is rare.Polycythemia is significantly associated with risk of venous thrombo...BACKGROUND Uterine myomas are the most common benign gynecological soft tissue tumors in women but polycythemia associated with these tumors is rare.Polycythemia is significantly associated with risk of venous thromboembolism(VTE),which is further increased in case of a large pelvic mass and obesity.Here we report the surgical challenges in the case of an obese patient with a giant fibromatous uterus and associated polycythemia.CASE SUMMARY A 42-year-old obese woman was referred to our department for treatment for a huge fibromatous uterus.She suffered of pelvic pressure and abdominal distension and reported severe dyspnea from several months.Laboratory analyses including hemoglobin(Hb)19.2 g/dL and hematocrit(Hct)59.7%were indicative of polycythemia.Arterial blood gas analysis showed arterial oxygen pressure(pO2)of 81.5 mmHg.Abdominal computed tomography confirmed a giant fibromatous uterus measuring 28.2 cm×17 cm×25 cm.To reduce the thromboembolic risk,the patient underwent low molecular weight heparin,phlebotomy twice before surgery,and we opted for a laparoscopic hysterectomy.The uterus weighed 5400 g and the histology confirmed a diagnosis of leiomyoma.We did not find increased erythropoietin levels in the supernatant of the myomatous uterine tissue.There were no complications.On postoperative day 1,the Hb and the Hct levels normalized to 13.3 g/dL and 41.7%,respectively.Arterial blood gas analysis after surgery showed a pO2 of 144.7 mmHg.These results suggested the diagnosis of myomatous erythrocytosis syndrome.The patient was discharged on the second postoperative day in very good condition with no symptoms.CONCLUSION We believe this is the first reported laparoscopic hysterectomy in a patient with a giant uterus,polycythemia and obesity.Multiple VTE risk factors warranted a laparoscopic approach.展开更多
Myoma of uterus has the highest incidence in gynecological tumors.The incidence rate is increasing year by year,which is the main indication for hysterectomy.Non-surgical treatment is often adopted for young patients ...Myoma of uterus has the highest incidence in gynecological tumors.The incidence rate is increasing year by year,which is the main indication for hysterectomy.Non-surgical treatment is often adopted for young patients with fertility requirements.The treatment methods for myoma of uterus are reviewed in this article.展开更多
BACKGROUND Uterine myoma is the most common benign tumor among women and is often accompanied by anemia.Here,we report the case of a patient with a very large leiomyoma but with a hemoglobin level as high as 197 g/L.A...BACKGROUND Uterine myoma is the most common benign tumor among women and is often accompanied by anemia.Here,we report the case of a patient with a very large leiomyoma but with a hemoglobin level as high as 197 g/L.After undergoing hysterectomy,all her hematological parameters returned to normal.Immunohistochemical staining of her myoma for erythropoietin showed strong positivity,which suggested that erythropoietin may be the cause of her erythrocytosis.A multidisciplinary team played a significant role in treating the disease.CASE SUMMARY A 47-year-old woman visited our department complaining that her abdomen had been continuously growing for the past 2 years.After careful examinations,she was suspected of having a very large leiomyoma.She was also diagnosed with erythrocytosis because her RBC count was 6.49×10^(12)/L,hemoglobin was 197 g/L.Following a multidisciplinary team consultation,bilateral ureteral stents were placed,and 800 m L blood was removed by phlebotomy.The patient then underwent hysterectomy and bilateral salpingectomy.She recovered well from the operation,and her hemoglobin level decreased sharply following the surgery.Low-molecular-weight heparin was administered daily to prevent postoperative thrombosis.She was discharged from the hospital on the fourth postoperative day.Two months later,all her hematological parameters returned to normal.Pathological analysis of the myoma revealed that it was a benign leiomyoma,with partial hyalinization,and strong positivity for erythropoietin in immunohistochemical staining suggested that erythropoietin may be responsible for the erythrocytosis.CONCLUSION Erythropoietin ectopically produced from the myoma was responsible for the erythrocytosis in this patient.A multidisciplinary team is strongly recommended.展开更多
Giant myomas, defined as those > 9 cm, are uncommon. Due to the difficulties caused by its enormous size, the usual surgical treatment is a simple total hysterectomy. The surgery may be performed by either laparosc...Giant myomas, defined as those > 9 cm, are uncommon. Due to the difficulties caused by its enormous size, the usual surgical treatment is a simple total hysterectomy. The surgery may be performed by either laparoscopy or laparotomy. However, the case presents a 45-year-old woman who was diagnosed with a giant myoma of 23 cm. The patient is asymptomatic and does not accept the indication of a simple total hysterectomy because of her fear to lose her femininity and a feeling of mutilation and unfulfilled genesic desire. A personalized procedure was performed: myomectomy by laparotomy with subsequent uterine reconstruction. The case is described to focus the interest on giant uterine myomas, taking into account the limited availability of literature on the topic, and to highlight the reconstruction after myomectomy.展开更多
Since myomectomy throughout cesarean deliv- ery may lead to hemorrhage and uterinal atony, it is not recommended. But, myomectomy has been reported during cesarean section in recent studies. We presented a patient wit...Since myomectomy throughout cesarean deliv- ery may lead to hemorrhage and uterinal atony, it is not recommended. But, myomectomy has been reported during cesarean section in recent studies. We presented a patient with large in- tramural myoma who was diagnosed at 34 weeks of pregnancy and operated with an unavoidable cesarean-combined myomectomy. A 33-year-old unpursued primigravida was referred to emer- gency department with abdominal pain and amenorrhea of 34 weeks duration. A sonographic diagnosis of myoma in pregnancy was made. Cesarean section was required for fetal distress and alive 2300 g weighted male infant with Ap- gar score of 6 at one minute, was born. As uterine incision could not be closed because of the myoma, myomectomy was performed dur- ing cesarean section unavoidably. A single 970 g and 15 × 18 cm sized myoma was removed. The physical examinations were unremarkable in the postoperative period. Although there are case series that have demonstrated the safety of myomectomy during cesarean section, we con-cluded that myomectomy during cesarean section is not a safe procedure accept inevitable situa-tions.展开更多
Hysterectomy for large uterine cervical myoma is a challenging surgical procedure due to the limited operative field for lateral and posterior dissections. Existing procedures such as performing myomectomy before hyst...Hysterectomy for large uterine cervical myoma is a challenging surgical procedure due to the limited operative field for lateral and posterior dissections. Existing procedures such as performing myomectomy before hysterectomy or performing retrograde hysterectomy remain suboptimal in expanding the operative field, especially in cases with a huge cervical myoma. In this report, we introduce a new procedure, the “HALF-CUTTING METHOD” which can be used to obtain an adequate surgical field during hysterectomy.展开更多
Objective To study the effectiveness and acceptability of the medical termination of early pregnancy accompanied with myoma Methods A total of 92 early pregnant women with myoma were admitted. Every woman was administ...Objective To study the effectiveness and acceptability of the medical termination of early pregnancy accompanied with myoma Methods A total of 92 early pregnant women with myoma were admitted. Every woman was administrated mifepristone 150 mg in the first two days and Misoprostol 1 000 μg on d 3.Results The complete abortion rate was 89. 13%. The average bleeding duration was 11. 89± 6. 87 d. The expulsion time of gestational cyst was affected by the size of myoma. The bleeding duration and the expulsion time of gestational cyst were affected by the size of myoma and gestational cyst. The location and the number of myoma had no effect on the bleeding duration and the recovery of menses.Conclusion Mifepristone and Misoprostol could be safely and effectively used in the termination of early pregnancy with myoma.展开更多
BACKGROUND Levonorgestrel-releasing intrauterine systems(LNG-IUSs)gradually release levonorgestrel into the uterus and is effective against hypermenorrhoea and dysmenorrhea.Complications associated with the insertion ...BACKGROUND Levonorgestrel-releasing intrauterine systems(LNG-IUSs)gradually release levonorgestrel into the uterus and is effective against hypermenorrhoea and dysmenorrhea.Complications associated with the insertion include expulsion,displacement,and uterine perforation.Ultrasonic identification of copper intrauterine devices(IUDs)is possible due to echogenicity from the copper coils.However,the barium sulfate coatings of LNG-IUSs do not always provide hyperechoic images.Both barium sulfate and copper are radiopaque and clearly identifiable on X-ray.Thus,X-ray imaging is required to locate LNG-IUSs.CASE SUMMARY A 46-year-old woman with hypermenorrhoea due to submucosal myomas was treated with LNG-IUS at another hospital.Three LNG-IUS insertions had apparently been followed by spontaneous expulsion,although objective confirmation using imaging was not performed.The patient was referred to our institution for surgery.At the first visit,there appeared to be no device in the uterus,and none was observed on transvaginal ultrasound.However,two LNGIUSs were observed in the pelvis on abdominal plain X-rays prior to surgery.Hysteroscopic myomectomy was performed,and the two LNG-IUSs were found to have perforated the myometrium.The devices were safely removed during surgery,and the submucosal myomas were also removed.The perforated section of the myometrium was minimal+ADs-therefore,a repair operation was not required.CONCLUSION Plain abdominal X-rays facilitate the determination of whether an LNG-IUS is in the uterine cavity.Therefore,it is important to confirm a device’s location,regardless of whether spontaneous expulsion is suspected,prior to inserting another device.展开更多
Objective： The purpose of this study was to search the ultrasound features of small intestinal stromal tumor （SIST） in women by reviewing their clinical data. Methods： The study group consisted of 18 female patien...Objective： The purpose of this study was to search the ultrasound features of small intestinal stromal tumor （SIST） in women by reviewing their clinical data. Methods： The study group consisted of 18 female patients with pathologically proven SIST in our hospital from 2000 to 2009. Medical records were reviewed for clinical information such as manifestation, findings of ultrasonography and immunohistochemical phenotype. Results： The average age of 18 female patients with SIST was 55.2 years （ranged, 39-84 years）. Seventeen cases of them had abnormal hypogastric masses, no mass in one case. The shapes of masses were round or Iobulate beside tightly uterus or ovary. The echo of masses was low. It＇s borders were clear and sometimes irregular. The sizes of the masses varied from 6.89-193.05 cm3, the diameter ranged from 24 tom-110 ram, 85.3% of which 50 mm-110 mm. There were rare color flow signals under color Doppler velocity mode or color Doppler power mode. Exploratory laparotomy confirmed that 16 cases of the tumors originated from small intestine, and 2 cases from the ileocecat. The positive rate of the immunohistochemical phenotype of CDl17 was 88.2%, and CD34 was 76.5%. The examination of pathology confirmed that 16 cases were malignant and 2 cases borderline tumors. Eighteen cases underwent radical surgical resection. Conclusion： The characteristics of SISTs in women pelvic cavity are： age 〉 40 years, a mass （proven not from productive system by ultrasonography） in pelvic cavity, melena, positive findings in pathology and CD117/CD34, especially notice masses which diameter is more than 50 mm and possess potential malignant. Ultrasonography is a convenient and effective tool of screening SISTs.展开更多
Objective: To check the effectiveness of tourniquet in the prevention of haemorrhage during myomectomies at the University Hospital of Brazzaville. Patients and methods: Analytical cross-sectional study, conducted at ...Objective: To check the effectiveness of tourniquet in the prevention of haemorrhage during myomectomies at the University Hospital of Brazzaville. Patients and methods: Analytical cross-sectional study, conducted at the University Hospital of Brazzaville from June 1, 2014 to June 30, 2016. Recruitment was performed by randomly matching each case of myomectomy performed using a tourniquet with two cases of myomectomy without tourniquet (50 cases vs 100 witnesses). We used as a tourniquet, the surgical glove knotted and tightened sufficiently at the level of the isthmus of the uterus to temporarily occlude the uterine arteries to ensure haemostasis lasting no more than one hour. Results: The mean age of the patients was similar in both groups (36, 1 ± 2.2 years vs 36.2 ± 1.9 years, P > 0.05). Menorrhagia was the most common indication of myomectomy in both groups (76% vs. 78% P > 0.05). The mean haemoglobin level of the patients before the myomectomies was 9.03 ± 1.10 g/dl vs 9, 75 ± 1.29 g/dl;P > 0.05. Intraoperative uterine features were similar in size (18 weeks gestation, 14 - 24) and number of myomas (5 vs 4, P > 0.05) in both groups. Polymyomectomy was more common in both groups (76% vs 73%, P > 0.05). Blood loss was reduced in the tourniquet group (90.5 ± 4.6 ml vs 200.4 ± 5.6 ml;P 0.05), as well as the use of blood transfusion (8% vs 50%, P 0.05). Use of the number of sutures was reduced in the group with tourniquet (3 ± 0.2 vs 6 ± 0.2 P 0.05). The duration of the procedure was shorter in the group with tourniquet (51.5 ± 4 min vs 83 ± 7 min, P 0.05). Postoperative mean haemoglobin of patients was no different between the two groups (9.4 ± 0.7 g/dl vs 9.2 ± 0.5, P > 0.05). The overall cost of management was reduced in the group with tourniquet (190,680 ± 1450 F CFA vs 256,800 ± 2350 FCFA;P 0.05). Conclusion: The use of tourniquet during myomectomies significantly reduces blood loss and the use of blood transfusion. We also obtain the notorious reduction in the use of sutures, the duration of interventions, and the overall cost of care. Thus, we encourage the systematic use of tourniquet during myomectomies by laparotomy.展开更多
文摘BACKGROUND Hypermenorrhea is characterized by excessive menstrual bleeding that causes severe anemia and interferes with everyday life.This condition can restrict women’s social activities and decrease their quality of life.Microwave endometrial ablation(MEA)using a 2.45-GHz energy source is a minimally invasive alternative to conventional hysterectomy for treating hypermenorrhea that is resistant to conservative treatment,triggered by systemic disease or medications,or caused by uterine myomas and fibrosis.The popularity of MEA has increased worldwide.Although MEA can safely and effectively treat submucous myomas,some patients may still experience recurrent hypermenorrhea postoperatively and may require additional treatment.AIM To investigate the efficacy of MEA combined with transcervical resection(TCR).METHODS Participants underwent cervical and endometrial evaluations.Magnetic resonance imaging and hysteroscopy were performed to evaluate the size and location of the myomas.TCR was performed before MEA using a hystero-resectoscope.MEA was performed using transabdominal ultrasound.The variables included operation time,number of ablation cycles,length of hospital stay,and visual analog scale cores for hypermenorrhea,dysmenorrhea,and treatment satisfaction at 3 and 6 mo postoperatively.The postoperative incidence of amenorrhea,changes in hemoglobin concentrations,and MEA-related complications were evaluated.RESULTS A total of 34 women underwent a combination of MEA and TCR during the study period.Two patients were excluded from the study as their histopathological tests identified uterine malignancies(uterine sarcoma and endometrial cancer).The 32 eligible women(6 nulliparous,26 multiparous)had a mean age of 45.2±4.3 years(range:36–52 years).Patients reported very severe hypermenorrhea(10/10 points on the visual analog scale)before the procedure.However,after the procedure,the hypermenorrhea scores decreased to 1.2±1.3 and 0.9±1.3 at 3 and 6 mo,respectively(P<0.001).The mean follow-up duration was 33.8±16.8 mo.Although 10 women(31.3%)developed amenorrhea during this period,none experienced a recurrence of hypermenorrhea.No surgical complications were observed.CONCLUSION Reducing the size of uterine myomas by combining MEA and TCR can safely and effectively treat hypermenorrhea in patients with submucous myomas.
文摘Introduction: Uterine fibroid is a mixed mesenchymal tumor, developing from smooth muscle cells of the myometrium, separated by connective tissue. The majority of fibroids are asymptomatic and do not require any intervention or other exploratory measures. However, in some cases fibroids are symptomatic, their treatment should aim to improve symptoms and quality of life. Objectives: Describe the epidemiological-clinical aspects of uterine fibroids in the gynecology and obstetrics department of the reference health center of commune VI of the Bamako district. Methodology: This was a retrospective descriptive study carried out over a period of one year. It concerns all patients seen in consultation in the gynecology and obstetrics department of the reference health center of commune VI. Results: during the study period, the uterine fibroid frequency was 1.80%. During this same period, fibroids represented 5.59% of gyneco-obstetric pathologies operated on in the department. The 30 - 45 year old age group was the most represented with a frequency of 75.63%. The average age was 36.87 years ± 6.2 years with extremes of 25 and 63 years. Married women were the most represented 97.48%. The vast majority of our patients 95.8% were not postmenopausal. The multigravidas were the most represented, i.e. 37.50% with a large part of the pauciparous 41.29%. In our patients, 96.64% had a clinical symptom on their fibroid with the main reason for consultation being the sensation of a pelvic mass in 97.48%. We recorded three cases of infertility as associated factors. Ultrasound was performed in all patients. The location of the myxomatous nuclei was subserosal in the majority in 42.86% and with multiple nodules in 84.85% of cases. The main indication for myomectomy was the failure of medical treatment in 86.49% of cases. Surgical treatment was mainly a myomectomy 93.30%, a hysterectomy was indicated in 6.70%. No cases of death were recorded. Conclusion: Uterine fibroid is a gynecological pathology that exists in our department;its frequency is estimated at 5.59%. For better management of fibroids, it is necessary to have a good knowledge of the factors favoring the occurrence of uterine fibroids, their growth and the symptoms to prevent the appearance of it or even at best to operate. This prevention must be a concern for public health because fibromatous pathology is frequent, costly and hampers quality of life.
文摘BACKGROUND Microwave endometrial ablation(MEA)is a minimally invasive treatment method for heavy menstrual bleeding.However,additional treatment is often required after recurrence of uterine myomas treated with MEA.Additionally,because this treatment ablates the endometrium,it is not indicated for patients planning to become pregnant.To overcome these issues,we devised a method for ultrasound-guided microwave ablation of uterine myoma feeder vessels.We report three patients successfully treated for heavy menstrual bleeding,secondary to uterine myoma,using our novel method.CASE SUMMARY All patients had a favorable postoperative course,were discharged within 4 h,and experienced no complications.Further,no postoperative recurrence of heavy menstrual bleeding was noted.Our method also reduced the myoma’s maximum diameter.CONCLUSION This method does not ablate the endometrium,suggesting its potential appli-cation in patients planning to become pregnant.
文摘Background：The relationship between intramural myomas and fertility remains unclear.The main debate rests on whether cavity-distorting intramural lnyomas （CDMs） adversely affect fertility more than non-CDMs.We aimed to compare the effects ofenucleating non-CDMs and CDMs on fertility improvement in females with unexplained infertility.Methods：We prospectively recruited 83 women undergoing myomectomy for unexplained infertility with intramural myomas between June 2008 and November 2012 and classified them into non-CDMs group （n =45） and CDMs group （n =38）.We then compared postoperative infertility rates,spontaneous pregnancy rates,pregnancy outcomes,live birth rates,and obstetric complications.For continuous variables,we calculated the mean ± standard deviation,median and interquartile range,and analyzed the data using Student＇s t-test and the Mann-Whitney U-test.For categorical variables,the Pearson＇s Chi-square test,the continuity correction test,and Fisher＇s exact test were used.Results：Patients＇ demographics and myoma characteristics were comparable between the two groups.The overall spontaneous pregnancy rate increased from 0% to 68.42% following myomectomy.The postoperative infertility rate was significantly higher in the non-CDMs group than that in the CDMs group （50.00% vs.23.53%,t =5.579,P =0.018）,whereas the postoperative spontaneous pregnancy rate was significantly lower in the non-CDMs group than that in the CDMs group （47.62% vs.70.59%,t 4.067,P =0.044）.Compared with the enucleation ofnon-CDM,the enucleation of CDM patients was a protective factor for the fertility restoration （risk ratio [RR] =3.717,95% confidence interval [CI]：1.284-10.753,P =0.015）,although postoperative fertility restoration declined with age （RR =1.141,95% CI：1.005-1.295,P =0.041）.Conclusions：Intramural myomas are associated with impaired fertility.Women experiencing unexplained infertility,and possessing intramural myomas,have a better chance of conception following myomectomy,and these benefits are more obvious for younger patients and patients with CDM.
文摘Aims: Infertility is a major problem in our current societies and the Fertilia medical clinic in Bamako is a center for medical assistance in procreation (MAP) where there is an increasingly growing demand for ultrasound. The objective of our study was to investigate the ultrasound causes likely to prevent the occurrence of pregnancy in a group of infertile and subfertile women. Subjects and Methods: This was a 5-year cross-sectional and prospective study, between January 2017 and January 2022, which involved 250 women wishing to become pregnant (infertile or subfertile), who came for pelvic ultrasound or follicular monitoring and who agreed to participate in our study. The parameters used were ultrasound reports including uterine, ovarian and tubal pathologies. It should be noted that in some cases no ultrasound cause of infertility was found. Data were entered and analyzed in SPSS. Results: 250 women were recruited into our. The average age was 32 years with extremes ranging from 17 to 51 years. 179 patients or 71.6% were between 17 and 35 years old. 139 patients or 55.6% had secondary infertility against 44.4% primary infertility. 202 patients or 80.8% had at least one ultrasound lesion and 48 patients or 19.2% had no significant ultrasound abnormality. The most represented ultrasound lesions were of uterine origin with 72.20%, 23.7% ovarian lesions and 04% tubal lesions. Uterine lesions were dominated by myomas, adenomyosis, endometrial polyps, uterine malformations and synechiae. As for ovarian lesions we noted cysts, polycystic ovary syndrome (PCOS), ovarian endometriosis, non-follicular ovaries and tubal ultrasound lesions showed unilateral or bilateral hydrosalpinx. Conclusion: In our study, ultrasound was an invaluable contribution to the diagnosis of the causes likely to explain subfertility and infertility in our respondents. She highlighted uterine, ovarian and tubal lesions, some of which could be corrected and pregnancies ensued.
文摘BACKGROUND Hysteromyoma is not a rare tumor among pregnant women.During pregnancy,the symptoms caused by hysteromyoma can be improved through conservative treatment in most cases.However,in order to ensure the safety of mothers and children,surgeries are necessary in some special cases.CASE SUMMARY We report a case of pregnancy complicated with hysteromyoma red degeneration.The patient had peritonitis after sudden abdominal pain during the 20th week of pregnancy.Laparoscopic exploration suggested rupture and bleeding of hysteromyoma,which were improved after drainage and an anti-inflammatory treatment.A cesarean section was performed after full term.This case shows the complications of rupture after red degeneration of hysteromyoma during pregnancy.CONCLUSION We should be alert to rupture of hysteromyoma during pregnancy,and active laparoscopic exploration is essential to improve the prognosis of such patients.
文摘BACKGROUND In the presence of a large uterus,total laparoscopic hysterectomy(TLH),always requires morcellation to allow removal of the tissues from the abdominal cavity.However,uncontained morcellation has been scrutinized because of the possible spread of occult leiomyosarcoma.Therefore,in-bag extracorporeal morcellation has been developed.However,tissue containment and extraction are extremely challenging,especially when considering the increasing uterine size to be removed through minimally invasive surgery.CASE SUMMARY Herein,we describe a novel technique for extracorporeal intrauterine morcellation using the uterus outermost layer as a bag to achieve tissue extraction of very large uteri with suspected occult leiomyosarcoma after TLH.The study enrolled patients who were planned for TLH for large uteri(weight>500 g).TLH was performed following the procedure reported in our previous studies.The novel technique has been described step-by-step in a video,which representatively describes the preoperative imaging and morcellation procedure of three very large uteri weighing 1500 g,1700 g,and 3700 g,respectively.The procedures were performed without any complications.The patients had an uneventful postoperative course,and in all cases,the pathology was benign leiomyoma.CONCLUSION Extracorporeal intrauterine morcellation using the uterus outmost layer as a bag was found to be a feasible technique that allows a careful diagnosis and safe removal of suspected occult malignancies.The technique herein presented may be adopted in surgical practice,by adding it to the other available techniques of contained morcellation.It may represent a valid and feasible alternative,especially useful in cases of very large uteri exceeding the capacity of specimen retrieval bags.
文摘子宫肌瘤是妇科最常见的良性肿瘤,子宫肌瘤合并妊娠占肌瘤患者的0.5%-1%,占妊娠者的0.3%-0.5%,黏膜下子宫肌瘤占肌瘤总数10%-15%。宫腔镜下子宫肌瘤电切术（transcervical resection of myoma,TCRM）是目前解决黏膜下肌瘤的较为理想的方法。本研究就黏膜下子宫肌瘤行TCRM术后对妊娠的影响进行临床分析。
基金The authors are thankful to the Foundation for Research Support from the State of Sao Paulo(Fundacao de Amparoà Pesquisa do Estado de Sao Paulo-FAPESP)for the financial support needed for the execution of this research project(grant number:07/52027-9).
文摘Arterial embolization of myomas (AEM) is an established option for the conservative treatment of uterine leio-myomas;it treats all present uterine nodules at once, is less invasive than other procedures and effective in controlling symptoms, and does not require long term hospitalizations. Nevertheless, the potential impact on endometrial morphological and functional outcomes after the procedure is still controversial based on reports of endometritis or eventual transient ischemia. This study evaluated endometrial reorganization in uterine leiomyoma patients, before and after AEM, through gene expression analyses of extracellular matrix and cytokines genes in theendometrial tissue. Eight patients with leiomyomas were evaluated before AEM and 6 months after. The examinations included transvaginal pelvic ultrasonography, dosing of the follicle-stimulating hormone, and endometrial biopsy during the second phase of the menstrual cycle. RNA was extracted from endometrial samples, cDNA was synthesized, and applied on PCR arrayTM plates to evaluate the expression of extracellular matrix (ECM) genes and cytokines and their receptors’ genes (CYT). The ECM overexpressed genes were MMP (1, 3, 10, 11, and 14), CTGF1, ICAM1, TBHS1, ITGA2, ITGA3, ITGB3, COL7A1, COL12A, SPP1, and TNC;ADAMTS8 was underexpressed. The CYT overexpressed genes were SPP1, BCL6, CXCL12, IL-8, and CEBPB;CXCL13 and CCL21 were underexpressed. The ECM results showed overexpression of proteases that are responsible for dysfunctions in the ECM, and of genes responsible for adhesion and membrane components. The CYT results showed overexpression of chemokines responsible for endometrial repair, and underexpression of cytokines involved in inflammatory processes in the endometrial tissue. AEM treatment did not negatively affect the endometrial function at 6 months after embolization. This study broadens the knowledge about using a procedure that is relevant to the treatment of leiomyomas and contributes to the establishment of future guidelines for the decision making process for physicians and patients.
文摘BACKGROUND Uterine myomas are the most common benign gynecological soft tissue tumors in women but polycythemia associated with these tumors is rare.Polycythemia is significantly associated with risk of venous thromboembolism(VTE),which is further increased in case of a large pelvic mass and obesity.Here we report the surgical challenges in the case of an obese patient with a giant fibromatous uterus and associated polycythemia.CASE SUMMARY A 42-year-old obese woman was referred to our department for treatment for a huge fibromatous uterus.She suffered of pelvic pressure and abdominal distension and reported severe dyspnea from several months.Laboratory analyses including hemoglobin(Hb)19.2 g/dL and hematocrit(Hct)59.7%were indicative of polycythemia.Arterial blood gas analysis showed arterial oxygen pressure(pO2)of 81.5 mmHg.Abdominal computed tomography confirmed a giant fibromatous uterus measuring 28.2 cm×17 cm×25 cm.To reduce the thromboembolic risk,the patient underwent low molecular weight heparin,phlebotomy twice before surgery,and we opted for a laparoscopic hysterectomy.The uterus weighed 5400 g and the histology confirmed a diagnosis of leiomyoma.We did not find increased erythropoietin levels in the supernatant of the myomatous uterine tissue.There were no complications.On postoperative day 1,the Hb and the Hct levels normalized to 13.3 g/dL and 41.7%,respectively.Arterial blood gas analysis after surgery showed a pO2 of 144.7 mmHg.These results suggested the diagnosis of myomatous erythrocytosis syndrome.The patient was discharged on the second postoperative day in very good condition with no symptoms.CONCLUSION We believe this is the first reported laparoscopic hysterectomy in a patient with a giant uterus,polycythemia and obesity.Multiple VTE risk factors warranted a laparoscopic approach.
基金Supported by Applied Basic Research Joint Special Fund Project of Yunnan Provincial Department of Science and Technology and Yunnan University of Traditional Chinese Medicine(2018FF001(-046))Key Laboratory of Dai and Yi Medicine in Yunnan Province(2017DG006)+1 种基金National Key Research Program of China(2017YFC1703901)Scientific Research Fund Project of Yunnan Provincial Department of Education(2017ZDX228)
文摘Myoma of uterus has the highest incidence in gynecological tumors.The incidence rate is increasing year by year,which is the main indication for hysterectomy.Non-surgical treatment is often adopted for young patients with fertility requirements.The treatment methods for myoma of uterus are reviewed in this article.
文摘BACKGROUND Uterine myoma is the most common benign tumor among women and is often accompanied by anemia.Here,we report the case of a patient with a very large leiomyoma but with a hemoglobin level as high as 197 g/L.After undergoing hysterectomy,all her hematological parameters returned to normal.Immunohistochemical staining of her myoma for erythropoietin showed strong positivity,which suggested that erythropoietin may be the cause of her erythrocytosis.A multidisciplinary team played a significant role in treating the disease.CASE SUMMARY A 47-year-old woman visited our department complaining that her abdomen had been continuously growing for the past 2 years.After careful examinations,she was suspected of having a very large leiomyoma.She was also diagnosed with erythrocytosis because her RBC count was 6.49×10^(12)/L,hemoglobin was 197 g/L.Following a multidisciplinary team consultation,bilateral ureteral stents were placed,and 800 m L blood was removed by phlebotomy.The patient then underwent hysterectomy and bilateral salpingectomy.She recovered well from the operation,and her hemoglobin level decreased sharply following the surgery.Low-molecular-weight heparin was administered daily to prevent postoperative thrombosis.She was discharged from the hospital on the fourth postoperative day.Two months later,all her hematological parameters returned to normal.Pathological analysis of the myoma revealed that it was a benign leiomyoma,with partial hyalinization,and strong positivity for erythropoietin in immunohistochemical staining suggested that erythropoietin may be responsible for the erythrocytosis.CONCLUSION Erythropoietin ectopically produced from the myoma was responsible for the erythrocytosis in this patient.A multidisciplinary team is strongly recommended.
文摘Giant myomas, defined as those > 9 cm, are uncommon. Due to the difficulties caused by its enormous size, the usual surgical treatment is a simple total hysterectomy. The surgery may be performed by either laparoscopy or laparotomy. However, the case presents a 45-year-old woman who was diagnosed with a giant myoma of 23 cm. The patient is asymptomatic and does not accept the indication of a simple total hysterectomy because of her fear to lose her femininity and a feeling of mutilation and unfulfilled genesic desire. A personalized procedure was performed: myomectomy by laparotomy with subsequent uterine reconstruction. The case is described to focus the interest on giant uterine myomas, taking into account the limited availability of literature on the topic, and to highlight the reconstruction after myomectomy.
文摘Since myomectomy throughout cesarean deliv- ery may lead to hemorrhage and uterinal atony, it is not recommended. But, myomectomy has been reported during cesarean section in recent studies. We presented a patient with large in- tramural myoma who was diagnosed at 34 weeks of pregnancy and operated with an unavoidable cesarean-combined myomectomy. A 33-year-old unpursued primigravida was referred to emer- gency department with abdominal pain and amenorrhea of 34 weeks duration. A sonographic diagnosis of myoma in pregnancy was made. Cesarean section was required for fetal distress and alive 2300 g weighted male infant with Ap- gar score of 6 at one minute, was born. As uterine incision could not be closed because of the myoma, myomectomy was performed dur- ing cesarean section unavoidably. A single 970 g and 15 × 18 cm sized myoma was removed. The physical examinations were unremarkable in the postoperative period. Although there are case series that have demonstrated the safety of myomectomy during cesarean section, we con-cluded that myomectomy during cesarean section is not a safe procedure accept inevitable situa-tions.
文摘Hysterectomy for large uterine cervical myoma is a challenging surgical procedure due to the limited operative field for lateral and posterior dissections. Existing procedures such as performing myomectomy before hysterectomy or performing retrograde hysterectomy remain suboptimal in expanding the operative field, especially in cases with a huge cervical myoma. In this report, we introduce a new procedure, the “HALF-CUTTING METHOD” which can be used to obtain an adequate surgical field during hysterectomy.
文摘Objective To study the effectiveness and acceptability of the medical termination of early pregnancy accompanied with myoma Methods A total of 92 early pregnant women with myoma were admitted. Every woman was administrated mifepristone 150 mg in the first two days and Misoprostol 1 000 μg on d 3.Results The complete abortion rate was 89. 13%. The average bleeding duration was 11. 89± 6. 87 d. The expulsion time of gestational cyst was affected by the size of myoma. The bleeding duration and the expulsion time of gestational cyst were affected by the size of myoma and gestational cyst. The location and the number of myoma had no effect on the bleeding duration and the recovery of menses.Conclusion Mifepristone and Misoprostol could be safely and effectively used in the termination of early pregnancy with myoma.
文摘BACKGROUND Levonorgestrel-releasing intrauterine systems(LNG-IUSs)gradually release levonorgestrel into the uterus and is effective against hypermenorrhoea and dysmenorrhea.Complications associated with the insertion include expulsion,displacement,and uterine perforation.Ultrasonic identification of copper intrauterine devices(IUDs)is possible due to echogenicity from the copper coils.However,the barium sulfate coatings of LNG-IUSs do not always provide hyperechoic images.Both barium sulfate and copper are radiopaque and clearly identifiable on X-ray.Thus,X-ray imaging is required to locate LNG-IUSs.CASE SUMMARY A 46-year-old woman with hypermenorrhoea due to submucosal myomas was treated with LNG-IUS at another hospital.Three LNG-IUS insertions had apparently been followed by spontaneous expulsion,although objective confirmation using imaging was not performed.The patient was referred to our institution for surgery.At the first visit,there appeared to be no device in the uterus,and none was observed on transvaginal ultrasound.However,two LNGIUSs were observed in the pelvis on abdominal plain X-rays prior to surgery.Hysteroscopic myomectomy was performed,and the two LNG-IUSs were found to have perforated the myometrium.The devices were safely removed during surgery,and the submucosal myomas were also removed.The perforated section of the myometrium was minimal+ADs-therefore,a repair operation was not required.CONCLUSION Plain abdominal X-rays facilitate the determination of whether an LNG-IUS is in the uterine cavity.Therefore,it is important to confirm a device’s location,regardless of whether spontaneous expulsion is suspected,prior to inserting another device.
文摘Objective： The purpose of this study was to search the ultrasound features of small intestinal stromal tumor （SIST） in women by reviewing their clinical data. Methods： The study group consisted of 18 female patients with pathologically proven SIST in our hospital from 2000 to 2009. Medical records were reviewed for clinical information such as manifestation, findings of ultrasonography and immunohistochemical phenotype. Results： The average age of 18 female patients with SIST was 55.2 years （ranged, 39-84 years）. Seventeen cases of them had abnormal hypogastric masses, no mass in one case. The shapes of masses were round or Iobulate beside tightly uterus or ovary. The echo of masses was low. It＇s borders were clear and sometimes irregular. The sizes of the masses varied from 6.89-193.05 cm3, the diameter ranged from 24 tom-110 ram, 85.3% of which 50 mm-110 mm. There were rare color flow signals under color Doppler velocity mode or color Doppler power mode. Exploratory laparotomy confirmed that 16 cases of the tumors originated from small intestine, and 2 cases from the ileocecat. The positive rate of the immunohistochemical phenotype of CDl17 was 88.2%, and CD34 was 76.5%. The examination of pathology confirmed that 16 cases were malignant and 2 cases borderline tumors. Eighteen cases underwent radical surgical resection. Conclusion： The characteristics of SISTs in women pelvic cavity are： age 〉 40 years, a mass （proven not from productive system by ultrasonography） in pelvic cavity, melena, positive findings in pathology and CD117/CD34, especially notice masses which diameter is more than 50 mm and possess potential malignant. Ultrasonography is a convenient and effective tool of screening SISTs.
文摘Objective: To check the effectiveness of tourniquet in the prevention of haemorrhage during myomectomies at the University Hospital of Brazzaville. Patients and methods: Analytical cross-sectional study, conducted at the University Hospital of Brazzaville from June 1, 2014 to June 30, 2016. Recruitment was performed by randomly matching each case of myomectomy performed using a tourniquet with two cases of myomectomy without tourniquet (50 cases vs 100 witnesses). We used as a tourniquet, the surgical glove knotted and tightened sufficiently at the level of the isthmus of the uterus to temporarily occlude the uterine arteries to ensure haemostasis lasting no more than one hour. Results: The mean age of the patients was similar in both groups (36, 1 ± 2.2 years vs 36.2 ± 1.9 years, P > 0.05). Menorrhagia was the most common indication of myomectomy in both groups (76% vs. 78% P > 0.05). The mean haemoglobin level of the patients before the myomectomies was 9.03 ± 1.10 g/dl vs 9, 75 ± 1.29 g/dl;P > 0.05. Intraoperative uterine features were similar in size (18 weeks gestation, 14 - 24) and number of myomas (5 vs 4, P > 0.05) in both groups. Polymyomectomy was more common in both groups (76% vs 73%, P > 0.05). Blood loss was reduced in the tourniquet group (90.5 ± 4.6 ml vs 200.4 ± 5.6 ml;P 0.05), as well as the use of blood transfusion (8% vs 50%, P 0.05). Use of the number of sutures was reduced in the group with tourniquet (3 ± 0.2 vs 6 ± 0.2 P 0.05). The duration of the procedure was shorter in the group with tourniquet (51.5 ± 4 min vs 83 ± 7 min, P 0.05). Postoperative mean haemoglobin of patients was no different between the two groups (9.4 ± 0.7 g/dl vs 9.2 ± 0.5, P > 0.05). The overall cost of management was reduced in the group with tourniquet (190,680 ± 1450 F CFA vs 256,800 ± 2350 FCFA;P 0.05). Conclusion: The use of tourniquet during myomectomies significantly reduces blood loss and the use of blood transfusion. We also obtain the notorious reduction in the use of sutures, the duration of interventions, and the overall cost of care. Thus, we encourage the systematic use of tourniquet during myomectomies by laparotomy.
