Myom Boyutlarının Sezaryen Myomektomi Sonuçlarına Etkisi

Yıl 2022, , 371 - 375, 01.09.2022

Feyza Bayram , Mehmet Musa Aslan

https://doi.org/10.26453/otjhs.1039351

Öz

Amaç: Sezaryen sırasında myomektomi uygulanan olgularda myom boyutunun intraoperatif ve postoperatif sonuçlara etkisini araştırmak.

Materyal ve Metot: Sezaryen myomektomi yapılan 89 hastanın sonuçları retrospektif olarak incelendi. Hastalar, myom boyutuna göre 2 gruba ayrıldı. Myomektomili hastalar, cutoff değeri olarak 5 cm baz alınarak değerlendirildi. İki grup arasında anne yaşı, doğumdaki gebelik haftası, yenidoğan ağırlığı, myom özellikleri, ameliyat öncesi ve sonrası hemoglobin (hb) değerleri, operasyon süresi ve transfüzyon ihtiyacı karşılaştırıldı.

Bulgular: Bu çalışmada, myom boyutu ≤5 cm olan (Grup-1) 65 gebeye ve myom boyutu >5 cm olan (Grup-2) 24 gebeye sezaryen sırasında myomektomi uygulandı. Ameliyat öncesi ve sonrası hb, ortalama hb değerleri, operasyon süresi ve hastanede kalış süresinde iki grup arasında istatistiksel olarak anlamlı fark bulunmadı. Bu çalışmada, en sık uterus anterior duvar (%56,1) yerleşimli, çapları 2 ile 5 cm (%70,7) aralığında değişen subserozal (%77,5) myomlar görüldü.

Sonuç: Deneyimli cerrahlar tarafından yapılan sezaryen sırasında myomektomi ameliyatı seçilmiş hastalarda myom boyutundan bağımsız olarak güvenli ve etkili bir yöntemdir. Ayrıca myom; sayısı, lokalizayonu, büyüklüğü ve hasta özellikleri açısından geniş bir hasta spektrumuna sahiptir. Bu nedenle tedavi kişiye özel olmalıdır. 

Anahtar Kelimeler

Myoma uteri, sezaryen, myomektomi

Destekleyen Kurum

Yok

Proje Numarası

Yok

Teşekkür

yok

The Effect of Myoma Size on Cesarean Myomectomy Results

Öz

Objective: To investigate the effect of myoma size on intraoperative and postoperative outcomes in patients with cesarean section myomectomy.

Materials and Methods: We retrospectively analyzed the data of 89 pregnant women who underwent cesarean section myomectomy. Study participants were divided into 2 groups according to fibroid size. Assessment of intramural myomectomy patients was carried out by taking 5 cm as the cutoff value. Maternal age, gestational age, neonatal weight, fibroid characteristics, pre- and postoperative hemogram values, operation time and transfusion need were compared between the two groups.

Results: Sixty-five women with myoma size ≤5 cm (Group-1) and 24 women with myoma size >5 cm (Group-2) underwent cesarean section myomectomy. There was no statistically significant difference between the two groups in terms of pre- and post-operative hemoglobin (hb), mean hb values, operation time and hospital stay. The most common fibroids in this study were subserosal fibroids (77.5%) located on the anterior uterine wall (56.1%) with a diameter of 2 to 5 cm (70.7%).

Conclusion: Cesarean section myomectomy performed by experienced surgeons can be performed as a safe and effective method in selected patients regardless of fibroid size. Moreover, fibroid has a wide spectrum of patients in terms of number, localization, size and patient characteristics. Therefore, treatment should be individualized. 

Anahtar Kelimeler

Cesarean section, myoma uteri, myomectomy

Proje Numarası

Yok

Kaynakça

• Wise LA, Laughlin-Tommaso SK. Epidemiology of uterine fibroids: From menarche to menopause. Clin Obstet Gynecol. 2016;59(1):2-24. doi:10.1097/GRF.0000000000000164
• Laughlin SK, Baird DD, Savitz DA, Herring AH, Hartmann KE. Prevalence of uterine leiomyomas in the first trimester of pregnancy: An ultrasound-screening study. Obstet Gynecol. 2009;113(3):630-635. doi:10.1097/AOG.0b013e318197bbaf
• Coleman-Cowger VH, Erickson K, Spong CY, Portnoy B, Croswell J, Schulkin J. Current practice of cesarean delivery on maternal request following the 2006 state-of-the-science conference. J Reprod Med. 2010;55(1-2):25-30.
• Sparić R, Malvasi A, Kadija S, Babović I, Nejković L, Tinelli A. Cesarean myomectomy trends and controversies: an appraisal. J Matern Fetal Neonatal Med. 2017;30(9):1114-1123. doi:10.1080/14767058.2016.1205024
• Leader A. Pregnancy and motherhood: The biological clock. Sex Reprod Menopause. 2006;4(1):3–6.
• Milazzo GN, Catalano A, Badia V, Mallozzi M, Caserta D. Myoma and myomectomy: Poor evidence concern in pregnancy. J Obstet Gynaecol Res. 2017;43(12):1789-1804. doi:10.1111/jog.13437
• El-Balat A, DeWilde RL, Schmeil I, ve ark. Modern myoma treatment in the last 20 years: A review of the literature. Biomed Res Int. 2018;2018:4593875. doi:10.1155/2018/4593875
• Pergialiotis V, Sinanidis I, Louloudis IE, Vichos T, Perrea DN, Doumouchtsis SK. Perioperative complications of cesarean delivery myomectomy: A meta-analysis. Obstet Gynecol. 2017;130(6):1295-1303. doi:10.1097/AOG.0000000000002342.
• Ehigiegba AE, Ande AB, Ojobo SI. Myomectomy during cesarean section. Int J Gynaecol Obstet. 2001;75(1):21-25. doi:10.1016/s0020-7292(01)00452-0
• Öktem M, Yanık F, Başer E, Kuzucu E. Sezaryen esnasında myomektomi yapılması. Uzmanlık Sonrası Eğitim ve Güncel Gelişmeler Dergisi. 2005;2:188-191.
• Akbas M, Mihmanli V, Bulut B, Temel I, Karahisar G, Demirayak G. Myomectomy for intramural fibroids during caesarean section: A therapeutic dilemma. J Obstet Gynaecol. 2017;37(2):141-145. doi:10.1080/01443615.2016.1229272
• Tinelli A. Myoma in pregnancy and cesarean myomectomy: A matter of debate for a long time. Int J Gynecol Clin Pract. 2014;1(104):2-3.
• Sakinci M, Turan G, Sanhal CY, ve ark. Analysis of myomectomy during cesarean section: A tertiary center experience. J Invest Surg. 2022;35(1):23-29. doi:10.1080/08941939.2020.1810832
• Dedes I, Schäffer L, Zimmermann R, Burkhardt T, Haslinger C. Outcome and risk factors of cesarean delivery with and without cesarean myomectomy in women with uterine myomatas. Arch Gynecol Obstet. 2017;295(1):27-32. doi:10.1007/s00404-016-4177-8
• Kaymak O, Ustunyurt E, Okyay RE, Kalyoncu S, Mollamahmutoglu L. Myomectomy during cesarean section. Int J Gynaecol Obstet. 2005;89(2):90-93. doi:10.1016/j.ijgo.2004.12.035
• Song D, Zhang W, Chames MC, Guo J. Myomectomy during cesarean delivery. Int J Gynaecol Obstet. 2013;121(3):208-213. doi:10.1016/j.ijgo.2013.01.021
• Goyal M, Dawood AS, Elbohoty SB, ve ark. Cesarean myomectomy in the last ten years; A true shift from contraindication to indication: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2021;256:145-157. doi:10.1016/j.ejogrb.2020.11.008
• Roman AS, Tabsh KM. Myomectomy at time of cesarean delivery: A retrospective cohort study. BMC Pregnancy Childbirth. 2004;4(1):14. doi:10.1186/1471-2393-4-14
• Zhao R, Wang X, Zou L, Zhang W. Outcomes of myomectomy at the time of cesarean section among pregnant women with uterine fibroids: A retrospective cohort study. Biomed Res Int. 2019;2019:7576934. doi:10.1155/2019/7576934
• Incebıyık A, Hilali NG, Camuzcuoglu A, Vural M, Camuzcuoglu H. Myomectomy during caesarean: A retrospective evaluation of 16 cases. Arch Gynecol Obstet. 2014;289(3):569-573. doi:10.1007/s00404-013-3019-1
• Kwon DH, Song JE, Yoon KR, Lee KY. The safety of cesarean myomectomy in women with large myomas. Obstet Gynecol Sci. 2014;57(5):367-372. doi:10.5468/ogs.2014.57.5.367
• Park BJ, Kim YW. Safety of cesarean myomectomy. J Obstet Gynaecol Res. 2009;35(5):906-911. doi:10.1111/j.1447-0756.2009.01121.x
• Li H, Du J, Jin L, Shi Z, Liu M. Myomectomy during cesarean section. Acta Obstet Gynecol Scand. 2009;88(2):183-186. doi:10.1080/00016340802635526
• Özcan A, Kopuz A, Turan V, ve ark. Cesarean myomectomy for solitary uterine fibroids: Is it a safe procedure?. Ginekol Pol. 2016;87(1):54-58. doi:10.17772/gp/57833
• Guler AE, Guler ZD, Kinci MF, Mungan MT. Myomectomy during cesarean section: Why do we abstain from?. J Obstet Gynaecol India. 2020;70(2):133-137. doi:10.1007/s13224-019-01303-6