Técnica da ligadura dos ramos ascendentes das artérias uterinas por via vaginal e seu efeito no tratamento da miomatose uterina

Abstract

Uterine Myomatosis is a worldwide Public Health problem, responsible for 30 to 40% of indications for hysterectomy. Efficient, safe, minimally invasive alternative and low costs therapeutics are needed. Some researchers have observed satisfactory results at promoting the reduction of blood flow to uterus, through the occlusion of uterus blood vessels via laparoscopy. 16 patients who presented uterine increased volume, uterine abnormal bleeding and pain, originated by myomatosis participated in this study. Patients who presented other concurrent causes such as uterine bleeding, pain or uterine volume increase such as cervix cancer or uterus endometrial cancer, adenomyosis and uterine polyps were excluded from this study. It was carried out a ligature technique of ascendant branches of uterine arteries via vaginal (LAUAV) and the repercussion on signals and symptoms above mentioned, as well as alterations of follicle stimulating hormone (FSH), of uterine images, and the level of general satisfaction with such medical proceeding have been evaluated. Occlusion of such vessels was carried out by the bottom of the anterior saccus, through incision of vaginal mucosa, at the level of vesico-cervical plica, from 10a.m. to 2 p.m., followed by section of supra-cervical and vesicouterine ligaments to deviate the bladder and the ureter. LAUAV was carried out under direct vision with specific material to work in such a small space. Patients have been accompanied during 6 months and the re-evaluated in relation to the commented parameters. Bleeding, pain and uterine volume, and the diameter of the dominant myoma has presented significant reduction and FSH has not presented statistically considerable difference, reflecting the preservation of ovarian reserve. No Complications have occurred. Patients’ satisfaction level attained 90%. LAUAV represents a secure, low-cost and efficient treatment of symptomatic myomatosis.