空隙雷射凝固术可以缩小子宫平滑肌瘤


  2002年8月30日─8月份《American Journal of Obstetrics and Gynecology》杂志报导的一项研究结果显示,空隙雷射凝固术(Interstitial laser photocoagulation,ILP)可能是外科手术切除中等大小的子宫平滑肌瘤的一种有效的替代方法。尽管研究中有一半患者有临床效益,但大于6cm的损害其治疗效果很差。研究人员推荐进行腹腔镜监测。
  
  英国伦敦大学医学院的Dr. Dilip Visvanathan指出,ILP是将光学纤维插入深藏在固体器官的损害中,以低功率雷射能量(不同于其它用于治疗肌瘤的,功率大得多的雷射技术)直接输送到目标损害中,吸收热量,因此导致局部凝结,而不会影响其上面的正常组织。
  
  此次研究的30个肌瘤是来自24位拒绝进行传统手术(开放性肌瘤切除术或者子宫切除术)的有症状的患者,接受ILP治疗,并且通过腹腔镜进行监测。手术耐受情况良好,有13位患者出现临床效益。尽管核磁共振成像或超音波显示,有23处损害出现缩小,但那些大于6cm的损害则效果不明显。
  
  在16位月经过多的患者中,7位有主观的改善;另外两位可以进行其它的替代治疗。在三位不孕的患者中,有一位在ILP33个月后,分娩一位健康的正常时间出生的婴儿。同时这三位患者有压迫症状,包括经常性频尿及骨盆疼痛的患者其症状得以缓解。
  
  所有患者对这种治疗,复原情况以及恢复正常活动的情况表示满意,且不比诊断性腹腔镜检查更令人不适,这使得较适合对患者进行日常的治疗。尽管我们的目标是记录单个肌瘤的反应,但过半患有月经过多的患者却也得到好处。ILP的主要的吸引力在于,可以重复并且不妨碍随后的正常手术治疗。
  
  
  
  

Interstitial Laser Photocoagul

By Laurie Barclay, MD
Medscape Medical News

Aug. 30, 2002 — Interstitial laser photocoagulation (ILP) may be an effective alternative to surgically resecting moderate sized uterine leiomyomas, according to results of a study in the August issue of the American Journal of Obstetrics and Gynecology. Although half the patients in the study had clinical benefit, lesions larger than 6 cm responded poorly. The investigators recommend laparoscopic surveillance.

"ILP involves the insertion of optical fibers into lesions deep within solid organs," writes Dilip Visvanathan, MRCOG, from the University College School of Medicine in London, U.K. "Low-power laser energy (in contrast to the much higher powers that are used in other laser techniques for the treatment of myomas) can then be delivered directly to the target lesion and is absorbed as heat, which causes localized coagulation without affecting the overlying normal tissues."

In this study, 30 myomas in 24 symptomatic patients who declined conventional surgery (open myomectomy or hysterectomy) received ILP and were monitored by laparoscopy. The procedure was well tolerated and offered clinical benefit to 13 patients. Although magnetic resonance imaging or ultrasound documented shrinkage in 23 lesions, those lesions larger than 6 cm in diameter responded poorly.

Of 16 patients with menorrhagia, seven had subjective improvement; in two others alternative treatment became possible. Of three patients with infertility, one delivered a healthy term infant 33 months after ILP. All three patients with pressure symptoms including frequency of micturition and pelvic pain got relief from ILP.

"All patients expressed satisfaction with the treatment, recovery, and return to normal activity and had no more discomfort than after a diagnostic laparoscopy, making day case treatment appropriate," the authors write. "Although our aim was to document the response of individual myomas, more than one half of those patients with menorrhagia benefitted.... Major attractions of ILP are that it is repeatable and that it does not prevent subsequent conventional surgical procedures."

Am J Obstet Gynecol. 2002;187:382-384

Reviewed by Charlotte E. Grayson, MD

    



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