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      The Changes of Surgical Treatment for Symptomatic Uterine Myomas in the Past 15 Years

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          Abstract

          Study Objective:

          The aim of this study is to elaborate the changes of the surgical approach of treatment for uterine myomas in Yangpu Hospital in the past 15 years.

          Design:

          This was retrospective cohort study.

          Setting:

          Yangpu Hospital, Tongji University School of Medicine, Shanghai, China.

          Materials and Methods:

          A total of 4113 patients with symptomatic uterine myomas underwent surgical treatments. Interventions: Eight kinds of different surgeries were involved in the study, including abdominal or laparoscopic surgery, hysterectomy, or uterus-sparing myomectomy.

          Measurements:

          The study collected patients' clinical data and reviewed surgical access and approach, complications, and the results of following up.

          Results:

          A total of 1559 cases (37.9%) underwent uterus-sparing myomectomy, 3005 cases (73.1%) performed laparoscopic surgeries. The percentage of laparoscopic surgery was significantly higher than homochronous data of laparotomy after 2003 ( P < 0.001). The per year total of uterus-reserved surgery was proved to be negatively correlated with patient's age ( R 2 = 0.930; P < 0.001). The rate of myomas recurrence was significantly lower in the combined myomectomy and uterine artery occlusion group (4%, 34/910) than in the single myomectomy group (10.5%, 44/420) ( P < 0.001).

          Conclusions:

          Retaining uterus and minimally invasive surgery were the important trends of surgical treatment for symptomatic uterine myomas. Laparoscopic uterus-sparing myomectomy may be an alternative to hysterectomy to manage to appropriate patients with uterine myomas.

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          Most cited references25

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          Uterine fibroids.

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            Uterine myomas: an overview of development, clinical features, and management.

            To review the biology and the pathophysiology of uterine myomas, focus on options for management, and emphasize principles that will render the decision-making process as logical as possible. Literature review and synthesis of the authors' experience and philosophy. Uterine myomas are the most common solid pelvic tumors in women. There is increasing evidence that they have a genetic basis and that their growth is related to genetic predisposition, hormonal influences, and various growth factors. Treatment choices are wide and include pharmacologic, surgical, and radiographically directed intervention. Most myomas can be followed serially with surveillance for development of symptoms or progressive growth. The past century has witnessed development of highly sophisticated diagnostic and therapeutic technology for myomas. The tools currently at our disposal permit greater management flexibility with safe options, which must be tailored to the individual clinical situation.
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              Is Open Access

              Uterine fibroids: current perspectives

              Uterine fibroids are a major cause of morbidity in women of a reproductive age (and sometimes even after menopause). There are several factors that are attributed to underlie the development and incidence of these common tumors, but this further corroborates their relatively unknown etiology. The most likely presentation of fibroids is by their effect on the woman’s menstrual cycle or pelvic pressure symptoms. Leiomyosarcoma is a very rare entity that should be suspected in postmenopausal women with fibroid growth (and no concurrent hormone replacement therapy). The gold standard diagnostic modality for uterine fibroids appears to be gray-scale ultrasonography, with magnetic resonance imaging being a close second option in complex clinical circumstances. The management of uterine fibroids can be approached medically, surgically, and even by minimal access techniques. The recent introduction of selective progesterone receptor modulators (SPRMs) and aromatase inhibitors has added more armamentarium to the medical options of treatment. Uterine artery embolization (UAE) has now been well-recognized as a uterine-sparing (fertility-preserving) method of treating fibroids. More recently, the introduction of ultrasound waves (MRgFUS) or radiofrequency (VizAblate™ and Acessa™) for uterine fibroid ablation has added to the options of minimal access treatment. More definite surgery in the form of myomectomy or hysterectomy can be performed via the minimal access or open route methods. Our article seeks to review the already established information on uterine fibroids with added emphasis on contemporary knowledge.
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                Author and article information

                Journal
                Gynecol Minim Invasive Ther
                Gynecol Minim Invasive Ther
                GMIT
                Gynecology and Minimally Invasive Therapy
                Medknow Publications & Media Pvt Ltd (India )
                2213-3070
                2213-3089
                Jan-Mar 2018
                16 February 2018
                : 7
                : 1
                : 10-15
                Affiliations
                [1 ]Department of Gynecology and Obstetrics, Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P.R.China
                [2 ]Department of Gynecology, Gynecologic Minimally Invasive Surgery Research Center, Tongji University School of Medicine, Shanghai, P.R.China
                [3 ]Department of Obstetrics and Gynecology, Yangpu Hospital, Tongji University School of Medicine, Shanghai, P.R.China
                Author notes
                Address for correspondence: Dr. Zhongping Cheng, Director of Department of Gynecology and Obstetrics, Tenth People's Hospital, Tongji University School of Medicine, 301, Yan Chang Road, 200072, Shanghai, P.R.China. E-mail: mdcheng18@ 123456263.net
                Article
                GMIT-7-10
                10.4103/GMIT.GMIT_11_17
                6135150
                351b97c6-0591-425f-af35-fc0aed49af5c
                Copyright: © 2018 Gynecology and Minimally Invasive Therapy

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                Categories
                Original Article

                laparoscopic uterine artery occlusion,laparoscopy,surgical management,uterine myomas,uterus-sparing myomectomy

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