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Abstract：
Background and Objectives: Uterine myomas represent one of the most prevalent pathologies affecting the female population. These benign neoplasms originate from the smooth muscular cells of the uterus, and they can be either single or multiple. Often associated with debilitating symptoms such as pelvic heaviness, pain, constipation, and urinary dysfunctions, the surgical management of myomectomy exhibits considerable variability. This diversity in approaches is influenced by factors such as the number and size of myomas, the patient\'s age, and overall clinical conditions. This study aims to elucidate and compare the advantages and disadvantages of different surgical approaches, specifically endoscopic procedures versus open surgery, providing valuable insights for clinical decision making. Materials and Methods: A comprehensive bibliographic search spanning from 2013 to 2023 was systematically conducted across databases including Medline, Embase, the Cochrane Database of Systematic Reviews, and ClinicalTrials.gov. The search utilized keywords such as \"myomectomy laparoscopic and open\", \"myomectomy open and minimally invasive\", \"myomectomy open and laparoscopic\", and \"myomectomy open vs. laparoscopic.\" The research methodology, along with predetermined inclusion and exclusion criteria, was established prior to the search, ensuring a systematic and rigorous approach. Subsequently, data analysis was carried out. Results: Following the study selection process, 25 articles met the eligibility criteria for inclusion in this analysis. The average numbers of myomas were 3.7 (ranging from 1 to 13.7) and 5.4 (ranging from 1 to 13.5) for the minimally invasive surgery and open surgery groups, respectively. In terms of myoma size, the total averages across studies were 7 cm (ranging from 4.8 to 14) for the minimally invasive group and 8 cm (ranging from 3.9 to 11.2) for the open surgery group. The average pregnancy and delivery rates were 29.7% (ranging from 1.8 to 100) for the minimally invasive group and 28.5% (ranging from 1.8 to 100) for the open surgery group. Regarding complications, the average rate was 14.2% (ranging from 0 to 50) for the endoscopic group and 22.3% (ranging from 0 to 60.3) for the laparotomic group. Conclusions: In conclusion, a critical factor influencing the choice of surgical approach is primarily the size and quantity of fibroids. The mini-laparotomic approach emerges as a viable alternative to endoscopy, demonstrating favorable surgical outcomes and aesthetic results. Interestingly, the type of surgical procedure appears to have no significant impact on the pregnancy rate.
摘要：
背景和目的：子宫肌瘤是影响女性人群的最常见病理之一。这些良性肿瘤起源于子宫的平滑肌细胞，它们可以是单个或多个。常伴有使人衰弱的症状，如骨盆沉重，疼痛,便秘,和泌尿功能障碍，子宫肌瘤切除术的手术治疗表现出相当大的差异。这种方法的多样性受到诸如肌瘤数量和大小等因素的影响，病人的年龄,和整体临床状况。本研究旨在阐明和比较不同手术入路的优缺点,特别是内窥镜手术与开放手术，为临床决策提供有价值的见解。材料与方法：2013年至2023年的全面书目搜索是在包括Medline在内的数据库中进行的，Embase,Cochrane系统评价数据库，和ClinicalTrials.gov.搜索使用了关键词，如“腹腔镜和开腹子宫肌瘤切除术”，“开放和微创子宫肌瘤切除术”，“开腹和腹腔镜子宫肌瘤切除术”，和“开放子宫肌瘤切除术与腹腔镜。“研究方法，以及预定的纳入和排除标准，是在搜索之前建立的，确保系统和严格的方法。随后，进行数据分析。结果：在研究选择过程中，25篇文章符合纳入本分析的资格标准。微创手术组和开放手术组肌瘤的平均数量分别为3.7例(1~13.7例)和5.4例(1~13.5例),分别。就肌瘤大小而言，微创组的研究总平均值为7cm(4.8~14),开放手术组为8cm(3.9~11.2).微创组的平均妊娠率和分娩率分别为29.7％（1.8至100）和开放手术组的28.5％（1.8至100）。关于并发症,内镜组为14.2%(0~50),开腹组为22.3%(0~60.3).结论：总之，影响手术方式选择的关键因素主要是肌瘤的大小和数量。微型开腹方法成为内窥镜检查的可行替代方法，表现出良好的手术效果和美学效果。有趣的是,外科手术的类型似乎对妊娠率没有显著影响.
