The Apply Of Pituitrin In Laparoscopic Myomectomy To Intramural Hysteromyoma

Background Hysteromyoma is the most common benign tumor of female genital organs. It can cause numbers of symptoms, such as menorrhagia, catamenia turbulence, urgent feeling of pelvic cavity and so on. It may be one of the reasons which may cause infertility. Nowadays, the main therapeutic method in dealing with hysteromyoma is the operation, including hysterectomy and myomectomy. Towards patients who want to maintain the integrity of their bodies and the procreation function of their uteruses, the selection of laparoscopic myomectomy is undoubtedly an ideal decision. Because of its shortinhospital period, little pain after operation, less pelvicadhesion, fast recovery and beautiful outlook of incision, more and more patients feel like to choose laparoscopic myomectomy. But there are still different views about whether we should take laparoscopic myomectomy as the main therapy to those patients who suffered from intramural hysteromyoma. The problem is whether the effect of suture technology done by laparoscopy is as reliable as those done by traditional abdominal ways, and also hemostasis is another problem. The suture technology has been accepted gradually as the pervasion of laparoscopic surgery and the improvement of the operation skill. How to reduce operative bleeding has become the main problem which surgeons take most interests in. Most of them choose oxytocin for uterine wall injection in order to enhance the uterine contraction to reduce the bleeding. But the clinical effect is not very well.Objectives In our research, we choose patients suffered from intramural tumour at random and divide them into two groups. We tried to compare the hemostatic effect, operative time, complication and side effect between pituitrin and oxtytocin.Materials and methods 70 patients suffered from laparoscopic myomectomy in Sir RunRun Shaw Hospital from January 2005 to December 2005 were choosed. Gynecologic examination and Ultrosound examination were given to all patients to make sure the diagnosis was intramural hysteromyoma, or multiple hysteromyomas with the biggest intramural one. The biggest diameter of hysteromyoma is less than 10cm, and the number of hysteromyoma is less than 5. They had obvious clinical symptoms or the sizes of uteruses are more than 10 week pregnancy. They needed operations but firstly they wanted to preserve the uteruses. Exclude the contraindications such as hemorrhagic disease, or accompany with severe hypertension and coronary heart disease and so on. According to the operation sequence, all patients were divided into two groups at random, odd number been classified into group A, even number been classified into group B. Of the patients in group A, mean age was 37.4±5.6 years, the mean diameter of the biggest hysteromyoma was 5.86± 1.58cm, and mean numbers of hysteromyoma were 2.7±0.7. The data in group B compared with group A were 36.8±6.3 years, 5.72±1.81cm, 2.6±0.5. We gave patients in group A 12" pituitrin with 0.9% NS 20ml while the other patients in group B were given oxytocin 20u with 0.9% NS 20ml by injected into uterine muscle.Then the doctors performed the operations in routine. The parameters we observed were systolic blood pressure change after the injection, operative bleeding, operative time, hemoglobin change after operation, anus gas discharge time, complication and inhospital days after operation.Results All the operations were successful, without severe complications happened. Mean bleeding volume between group A and B was 52.6±23.3ml vs 123.4±38.5ml, p<0.01;and mean operative time was 82.5±25.8min vs 110.4±28.6min, p<0.01. As to blood pressure change, both groups systolic blood pressure increased 15 minutes after injection, there was significant difference between them. And there was no significant blood pressure increasing after 30 and 60 minutes in both groups. The first day after operation, hemoglobin deceased 4.1±1.8g/L in group A and 9.7±3.1 g/ L in group B, p<0.01. But no differences were found in anus gas discharge, side effect and inhospital days after operation. All the pathologic reports were uterine leiomyoma.Conclusion The hemostatic effect of pituitrin local injection into uterus is affirmed in laparoscopic myomectomy to intramuralhysteromyoma. Pituitrin is more effective than oxytocin. There are no significant differences on both complications and recovery after operation. Its application is worthy to be taken spreaded.