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Presented by :
Kezia Nathania
1765050190
Facilitator :
Dr. Maruarar Panjaitan, Sp.OG
• Statistical analysis
Analyzed using SSS 20.0 statical analysis software.
Measurement data -> as mean ± standard deviation (mean ± SD)
Enumeration data -. as percentage (%) and Chi-square test -> for comparison amoung group.
P<0.05 indicate a statisticaly significant difference.
Results
• Pathological diagnosis of submucous myoma of the uterus
Modified SHG + USG needle biopsy -> 24 out of 25 cases (96%) -> pathological as submucous myoma
of the uterus
o Type 0 : 6 cases - Type 0 : Complete disappeared (after treatment)
o Type I : 14 cases - Type I, II: 18 cases submucous myoma intramural myoma (after treatment)
o Type II : 4 cases
Results
• Pathological diagnosis of submucous myoma of the uterus
Significant differences of submucous myoma of the uterus before and after treatment (P<0.05)
(table I)
• Blood flow grading of patient with submucous myoma of the uterus before and
after treatment
Before treatment, After treatment
o Grade 0 -> 0 case 14 cases
o Grade I -> 3 case 6 cases
o Grade II -> 7 case 5 cases
o grade III -> 7 case 0 cases
Discussion
• Myoma uterus long menstrual period, profuse menstruation, severe cases -> anemi and infertility
• Clinical treatment method of myoma the uterus : laparascopic fibroidectomy
Disadvantage : General anesthesia and higher cost,
Uterine arteri embolization,
Postoperative adverse reaction.
• Patients receiving surgical treatment longer recovery period after treatment.
• Patients receiving interventional ultrasaound-guided puncture injection of lauromacrogol :
Short recovery
Do not need hospitalized
• Clinical studies : ethyl alchol as the hardening agent in the treatment of myoma.
Better clinical effect but adverse reaction after operation.
Disscusion
• Lauromacrogol -> a kind of ether compound.
Endothelial cell in cystic wall > secretion function to produce aseptic inflammation.
Cystic adhesions
Closure and grandual absorption (used in slerotherapy of cysts in clinical practice in previous years)
• Incidence rate of myoma 5-10% it can cause more serious clinical symtoms :
Excessive menstruation - Shortened menstrual cycle
Prolonged menstrual period - Dysmenorea, anemia and fertility
• Modified SHG -> 18GTC puncture needle tip -> placed in the uterine cavity ->
Slowl infused appropriate amount of normal saline -> No echo liquid dark area in the uterine cavity
Forming a good acoustic window and contrast area -> Affective improve the display rate of lesion structure.
• SHG modified -> unique superiority in the typping of submucous myoma
Avoid myoma surface bleeding and other complications due to blind curratage
Asses percentage of tumor to the uterus cavity
Help select the apropiate clinical resection mode of myoma
• Underwent ultrasound-guided sclerotherapy, SHG needed before treatment :
Inject normal saline -> separate the uterine cavity and the source of myoma pedicle can be clear
Protect the endometrium, -> prevent fluid infiltrate into the uterine
• After scleroteraphy :
6 cases of type 0 submucous myoma shrunk -> blood supply was block
18 cases of type I, II submucous myoma -> significant reduced
Diameter submucous myoma before treatment : 3.25 ±0.47 -> 2.02 ±0.23 cm
Volume before treatment: 25.91 ± 3.47cmᶟ -> 18.15±2.93 cmᶟ
A total of 14 cases -> completely inactived
4 cases -> partially inactivated
• After treatment :
Menstrual period, anemia, hemachrome level, blood flow grading -> obivious improve (P<0.05)
Efek mechanism of intratumor injection of lauromacrogol -> destruction
o Coagulation
o Degeneration of myoma capsule
o Vascular embolization
• Adverse reaction of patient renal cycst and liver cycst : sclerotherapy lauromacrogol > absolute ethyl
After treatment : mild abdominal pain
Slight vaginal bleeding, pale complexion
Cold sweat, dizziness and other
Dissapeared for 1 week.
• Lauromacrogol -> lead to the denaturation
Slight anesthetic,
Alleviate postoperstive pain,
Improve the patient tolerance.
• The score of each dimension -> after treatment significant > before treatment
• The score of SF-36 significant different before and after treatment (P<0.05)
Conclusion
• The interventional ultrasonography can effectively diagnose submucous myoma of the uterus.
• The treatment of submucous myoma :
Effectively reduce of the tumor diameter and volume,
Improve the blood flow in patients,
Reduced the postoperative adverse reaction,
Alleviate the patients’s pain.
• Invasive treatment method worthy of clinical promotion and application.