Usporedba dviju izvornih tehnika rekonstrukcije stijenke maternice pri laparoskopskoj enukleaciji intramuralnog mioma

Strelec, Mihajlo (2004) Usporedba dviju izvornih tehnika rekonstrukcije stijenke maternice pri laparoskopskoj enukleaciji intramuralnog mioma. PhD thesis, Sveučilište u Zagrebu.

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Abstract

The optimal technique of uterine wall reconstruction during laparoscopic enucleation of intramural fibroid is still not defined. Two original laparoscopic techniques were compared in the current study on 60 patients with an intramural fibroid with a diameter of between 3-10 cm. In 44 patients the uterine wall was sutured with the single suture technique, using monofilament suture for open surgery, knotted extracorporeally in Weston gliding knot and tied using originally designed reusable knot pusher. (SS) In 16 patients the uterine wall was reconstructed using the originally developed technique of single continuous spiraling suture (SCSS) using monofilament suture for open surgery, tied extracorporeally with Clarke-Reich knot pusher. There was no significant difference in the age distribution and parity between the two groups of patients, as well as in the distribution of the size of fibroids. The average suturing time in the SS group was 30.9+17 minutes, as compared to 23.3+13 minutes in the SCSS group. No significant difference was observed between these two groups. The median operation time was 100 minutes in both groups. The cost of suturing was 5-fold higher in the SS group since an average number of 4.8 sutures were used for each patient in this group. Since there were neither short-term nor long-term complications in both of patients we conclude that both presented techniques of uterine wall reconstruction after laparoscopic enucleation of intramural fibroids are efficient and safe.

Abstract in Croatian

Do danas još nije definirana optimalna tehnika rekonstrukcije materične stjenke nakon laparoskopske enukleacije intramuralnog mioma. Dvije izvorne tehnike su uspoređene u studiji na 60 pacijentica operiranih zbog intramuralnog mioma promjera između 3 i 10 cm. U 44 pacijentice materična stjenka je rekonstruirana tehnikom pojedinačnih šavi. Korišteni su monofilamentni ili polifilamentni konci namijenjeni otvorenoj kirurgiji. Vezani su ekstrakorporalnim Westonovim kližućim čvorom koristeći izvorno konstruiran spuštač čvora. (MPKŠ) U 16 pacijentica materična stjenka rekonstruirana je izvornom stvorenom tehnikom produžnog spiralnog šivanja. (PSŠ) Upotrijebljeni su monofilamentni konci vezani ekstrakorporalno uz korištenje Clarke-Reichovog spuštača čvora. Obje grupe nisu se značajno razlikovale po dobi, po paritetu ili po veličini mioma. Prosječno vrijeme utrošeno za rekonstrukciju materične stjenke u MPKŠ grupi bilo je 30,9+17 minuta a u PSŠ grupi 23,3+13 minuta. Razlika nije bila statistički značajna. U SS grupi cijena utrošenog konca je 5 puta viša od one u SCSS grupi zbog prosječno 4,8 potrošenih konaca za svaku pacijenticu. Budući da ni u jednoj grupi nije bilo niti ranih niti kasnih postoperativnih komplikacija, zaključujemo da su obje tehnike rekonstrukcije materične stjenke nakon laparoskopske enukleacije intramuralnog mioma učinkovite i sigurne.

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