Dosis óptima de vasopresina en miomectomía laparoscópica para fibromas uterinos
Dosis de vasopresina en miomectomía
El leiomioma uterino es el tumor benigno más común en mujeres en edad reproductiva con una incidencia de hasta 70% ~ 80%. Alrededor del 20% al 50% de las mujeres con leiomioma uterino presentan síntomas. La miomectomía es el tratamiento estándar para las mujeres que desean preservar su útero para la fertilidad. La cirugía, sin embargo, puede estar asociada con un riesgo de sangrado 4, que dificulta la visión quirúrgica, prolonga el tiempo operatorio y aumenta las complicaciones. La vasopresina se inyecta de forma rutinaria en el mioma para la vasoconstricción y la hidro separación.
Objective: To determine the optimal effective dose of pituitrin in laparoscopic myomectomy for uterine leiomyoma. Design: Prospective, double-blinded, randomized controlled trial. Setting: A tertiary women’s hospital in China. Population: A total of 118 women underwent laparoscopic myomectomy. Methods: Women were randomly divided into four groups to receive 0, 2, 4, or 6 units of pituitrin in the leiomyoma (groups 0U, 2U, 4U, and 6U, respectively).
Main outcome measures: Rate of the satisfactory surgical field, hemodynamic changes, total surgical time, and blood loss were recorded. Results: The rate of the satisfactory surgical field was 6.7%, 72.4%, 89.7%, and 93.3% in groups 0U, 2U, 4U, and 6U, respectively; it was higher in groups 2U, 4U, and 6U than group 0U, but there were no significant differences among the groups 2U, 4U, and 6U. The blood loss was higher in group 0U than that in groups 2U, 4U, and 6U ().
Pituitrin was associated with a transient decrease in blood pressures and increase in heart rate in a dose-dependent fashion, with more pronounced changes in groups 4U and 6U and these groups also required a higher amount of vasoactive drug to correct hemodynamic changes (p<0.05).
Conclusions: The use of low-dose pituitrin (2 units) provides a satisfactory surgical field with minimal hemodynamic changes.
