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Geburtshilfe Frauenheilkd 2000; 60(5): 264-268
DOI: 10.1055/s-2000-9531
Originalarbeit

Georg Thieme Verlag Stuttgart · New York

Erfolgsfaktoren der Myomenukleation bei Sterilitätspatientinnen unter besonderer Berücksichtigung der mikrochirurgischen Operationstechnik

Open Myomectomy With Microsurgical Principles in Infertile PatientsS.  Schmidt, G. Stirner, U. Wagner, F. Sierra, K. Swolin†, D. Krebs
  • Universitäts-Frauenklinik Bonn
Further Information

Publication History

Publication Date:
31 December 2000 (online)

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Zusammenfassung

Fragestellung

Fragestellung: Die operative Behandlung von Sterilitätspatientinnen mit Myomen durch Myomennukleation dient dem Ziel, postoperativ die Schwangerschaftsrate zu erhöhen.

Material und Methodik

Material und Methodik: In einer retrospektiven Analyse an einem Kollektiv von 90 Patientinnen, die per Laparotomie operiert wurden, evaluierten wir die Faktoren des Operationserfolges.

Ergebnisse

Ergebnisse: Während im Gesamtkollektiv die postoperative Schwangerschaftsrate bei 36 % lag, fand sich bei unkompliziertem morphologischen Restbefund eine Rate von 43 %. Ergaben sich intraoperativ morphologische Zusatzbefunde wie Adhäsionen, Tubenverschluss und Endometriose, reduzierte sich die Rate auf 25 % respektive 19 %. Ein hoher intraoperativer Blutverlust verminderte die Schwangerschaftsrate auf 24 %. Als günstig zeigt sich das blutungsarme Vorgehen durch Elektromikrochirurgie nach Swolin, wonach die Schwangerschaftsrate mit 47 % deutlich höher lag.

Schlussfolgerung

Schlussfolgerung: Diese Ergebnisse implizieren einen klinischen Nutzen des schonenden operativen Vorgehens bei Sterilitätspatientinnen.

Summary

Objective

Objective: To review pregnancy rates after open myomectomy and evaluate the influence of microsurgical principles.

Methods

Methods: We reviewed 90 patients with infertility who underwent open myomectomy. Nineteen of these patients underwent surgery following microsurgical principles outlined by Swolin.

Results

Results: The overall postoperative pregnancy rate was 36 %. The pregnancy rate in patients with a morphologically normal uterurs was 43 % after myomectomy but 25 % to 19 % in patients with adhesions, tubal occlusion or endometriosis, respectively. The pregancy rate in patients with marked intraoperative blood loss was 24 %. The pregnancy rate in patients operated on following microsurgical principles was 47 %.

Conclusion

Conclusion: These results suggest that microsurgical principles with gentle tissue handling at myomectomy have a favorable effect on postoperative pregnancy rates.

Schlüsselwörter:

Sterilität - Myom - Myomenukleation - Infertilitätschirurgie - Mikrochirurgie - Adhäsionen - Endometriose

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Prof. Dr. med. S. Schmidt

MZ für Frauenheilkunde Geburtshilfe und Perinatalmedizin Philipps-Universität Marburg

Pilgrimstein 3

35037 Marburg