Laparoskopik Myomektomi Sonrası Belirgin Hemoglobin Düşüşüne Etki Eden Faktörlerin Belirlenmesi
Year 2020,
Volume: 17 Issue: 2, 354 - 356, 25.06.2020
Bulut Varlı
,
Kaan Baydemir
,
Yavuz Şükür
,
Bülent Berker
Abstract
Amaç: Laparoskopik myomektomi sırasında belirgin hemorajiye neden olarak postoperatif hemoglobin düşüşüne etki eden faktörlerin belirlenmesi
Gereç ve Yöntem: Tersiyer merkezde 5 yıllık süre boyunca laparoskopik myomektomi operasyonu geçiren ve hastane bilgi yönetimi sistemine verileri eksiksiz girilmiş hastaların dosyaları retrospektif olarak incelendi. Çalışmaya toplam 152 hasta dahil edildi. Tüm hastalardan postoperatif 8. saatte hemogram kontrolü yapıldı. Preoperatif hemoglobin değerinin 2 g/dL azalması belirgin hemoraji olarak kabul edildi. Vaka grubu 38, kontrol grubu 114 hasta içermekteydi. Gruplar; toplam myom boyutu, dominant myom boyutu, 1’den fazla myom varlığı gibi intraoperatif hemorajiye neden olabilecek faktörler açısından karşılaştırıldı.
Bulgular: Dominant myom boyutunun 6 cm’den büyük olması ve 1’den fazla sayıda myomun çıkarılması postoperatif belirgin hemoglobin düşüşüne neden olsa da hastanede kalış süresi bu durumdan olumsuz olarak etkilenmemektedir.
Sonuç: Laparoskopik myomektomi öncesi her hasta mutlaka görüntüleme yöntemleriyle değerlendirilmeli ve myomlar haritalandırılarak cerrahi yaklaşım buna göre belirlenmelidir. Çok sayıda myom varlığı veya dominant myomun büyük olduğu durumlarda hastalar ameliyat öncesi dönemde transfüzyon ihtiyacı ve laparotomiye dönüş hakkında bilgilendirilmeli, intraoperatif hemostaz konusunda dikkatli olunmalıdır.
References
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Year 2020,
Volume: 17 Issue: 2, 354 - 356, 25.06.2020
Bulut Varlı
,
Kaan Baydemir
,
Yavuz Şükür
,
Bülent Berker
References
- Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol 2003;188(1):100-7.
- Stewart EA. Uterine fibroids. The Lancet 2001;357(9252): 293-8.
- Alternatives to Hysterectomy in the Management of Leiomyomas. ACOG Practice Bulletin No. 96. American College of Obstetricians and Gynecologists. Obstet Gynecol 2008; 112: 201.
- Saridogan E, Cutner A. Endoscopic management of uterine fibroids. Hum Fertil (Camb) 2006; 9:201–8.
- Saridogan E. Surgical treatment of fibroids in heavy menstrual bleeding. Womens Health (Lond) 2016; 12:53–62.
- Bhave Chittawar P, Franik S, Pouwer AW, Farquhar C. Minimally invasive surgical techniques versus open myomectomy for uterine fibroids. Cochrane Database Syst Rev. 2014; CD004638.
- Sizzi O, Rossetti A, Malzoni M, Minelli L, La Grotta F, Soranna L, Panunzi S, Spagnolo R, Imperato F, Landi S, Fiaccamento A, Stola E. Italian multicenter study on complications of laparoscopic myomectomy. J Minim Invasive Gynecol 2007;14(4):453-62
- Oshima M, Shimada Y, Takeuchi H, Kinoshita K. Blood loss estimation during laparoscopic myomectomy using HemoCue. J Nippon Med Sch 2005; 72: 226-9.
- Bean EMR, Cutner A, Holland T, Vashisht A, Jurkovic D, Saridogan E. Laparoscopic myomectomy: a single-center retrospective review of 514 patients. J Minim Invasive Gynecol 2017;24(3), 485-93
- Agdi M, Tulandi T. Endoscopic management of uterine fibroids. Best Pract Res Clin Obstet Gynaecol 2008; 22(4): 707-16.
- Vargas MV, Moawad GN, Sievers C, Opoku-Anane J, Marfori CQ, Tyan P, Robinson JK. Feasibility, safety, and prediction of complications for minimally invasive myomectomy in women with large and numerous myomata. J Minim Invasive Gynecol 2017;24(2): 315-22.
- Dubuisson JB, Chapron C, Levy L. Difficulties and complications of laparoscopic myomectomy. J Gynecol Surg 1996,12(3):159–65.
- Sandberg EM, Cohen SL, Jansen FW, Einarsson JI. Laparoscopic Myomectomy as a New Standard: An Analysis of Risk Factors for Conversion. J Minim Invasive Gynecol. 2015 Nov-Dec;22(6S): S62.
- Mallick R, Odejinmi F. Pushing the boundaries of laparoscopic myomectomy: a comparative analysis of peri-operative outcomes in 323 women undergoing laparoscopic myomectomy in a tertiary referral centre. Gynecol Surg. 2017; 14(1): 22-9.