The Clinical Value Of Multi-channel Ultrasonic Dynamic Monitoring During Perioperative Period Of Laparoscopic Myomectomy

Objective: To evaluate the effectiveness of multiple ultrasonography during laparoscopic myomectomy perioperative period.Methods: A total of 169 women,underwent laparoscopic myomectomy(LAPM),were monitored by multiple ultrasonography,including abdominal,transvaginal,transrectal ultrasonography and laparoscopic ultrasound(LUS),during the perioperative period.Firstly,before the operation,abdominal ultrasonography was used to monitor bowel adhesion below their navel for patients who had undergone abdominal surgery.Transvaginal ultrasonography or combined with abdominal ultrasonography was to evaluate the number,location,size of the uterine fibroids.Secondly,transvaginal ultrasonography or combined with LUS could monitor the location of fibroids and help us find them to remove them.At the same time,transvaginal ultrasonography was used to monitor the relationship between the fibroids at special position and the surrounding tissues,in order to reduce the injury of endometrium and cervical canal,monitor the appearance of the hematoma at the suture site.Lastly,transvaginal ultrasonography was used to evaluate the residual fibroids situation.If somebody did not have sexual history,she was measured by transrectal ultrasonography instead of the transvaginal.Results: Among the 169 cases,we enucleated 721 fibroids in all,431 fibroids among which were enucleated without ultrasonography guidance,while the other 282 fibroids were enucleated depending on ultrasound assistance,8 fibroids depending on hysteroscopy.What is more,37 cases avoided hurting their endometrium under the guide of the ultrasonography.Intraoperative ultrasonography detected hematoma in 3 women and pelvic hidden lesions in 5 cases.2 cases were found bowel wriggle was limited under the first puncture site by abdominal ultrasonography monitoring and were changed puncture site.Thanks to the "pick up way" that removed 156 uterine fibroids,which was accounting for 21.63% of the removed fibroids.Conclusions: Dynamic multipath ultrasonography is used during the laparoscopic myomectomy perioperative period,which can prevent the damage of the umbilical incision,assist operators to select the appropriate fibroids excision ways,reduce the residual fibroids and the risk of intraoperative endometrium injury,discover the hematoma timely,reduce the perioperative complications.The way of "pick up way" is the effective method to eliminate style 3 or 4 fibroids with the guidance of ultrasonography.Objective: To evaluate the uterine perfusion and healing after laparoscopic myomectomy with the ultrasonography.Methods: Ultrasonography was used to evaluate the patients on 2 days,1 month,2 months and 3 months postoperatively.Resistance index,pulsatility index and size of the uterine scar were measured.In addition,the uterine hematoma formation and pelvic effusion were evaluated by the ultrasonography.Results: Postoperatively,we used ultrasonography to evaluate the uterine scar area of the 58 patients.The average size of the uterine scar was 4.48 cm on 2th day,0.83 cm on first month,and 0.14 cm on 3rd month,0cm on 6th month.The uterine examination showed a significant(P< 0.05)progressive reduction of uterine scar area from 18.41% of the 2th day on the 1st month,to 3.23% on 3rd month,and,the scar area became normal on the 6th month.After 2 day,the RI was elevated to 0.72.After 1month,the RI was always elevated to 0.71,and then the RI increased to 0.87 at the 3rd post-operative month and to 0.85 at the 6th post-operative month.The difference between 1st month and 3rd month is significant(P< 0.05).While the PI was elevated to 1.48,1.50,2.28,2.24 at second day,1st month,3rd month,6th month after the surgery respectively.The difference between 1st month and 3rd month also is significant(P< 0.05).One patient with hematoma formation in the scar area,and at the 1st postoperative month the hematoma had been completely absorbed.Conclusions: uterine perfusion recovery process is complete at 3after myomectomy if there are no clear findings of hematoma or edema formation in the myometrium.The uterine recovery completely need 6month.Establishment of a pregnancy should be delayed for at least 6 months following an incision of the uterus to avoid the uterine rupture morbidity.