宫腔镜电切术治疗子宫肌瘤962例疗效分析

Transcervical resection of myoma in treatment of hysteromyoma: experience in 962 x\cases

目的探讨宫腔镜电切子宫肌瘤(TCRM)的手术方法及预后. 方法对962例子宫肌瘤患者进行了TCRM手术,术中进行B超声或腹腔镜监护.962例中0型子宫肌瘤281例,Ⅰ型316例,Ⅱ型282例,多发黏膜下及壁间肌瘤34例,宫颈肌瘤11例,脱出肌瘤23例,子宫腺肌瘤15例.用TCRM五步手法实施手术.结果 962例患者的子宫大小平均为孕(7.4±1.3)周(5～11周),宫腔深度平均(8.3±1.4)cm(7～13 cm),切除肌瘤最大直径为7.2 cm.一次手术成功率为99.77%.切除肌瘤重量平均(23±31)g(4～145 g).手术时间平均(32±173) min(9～145 min).术中出血平均(8±19) ml(5～400 ml),无输血者.并发症为:一过性发热3例,子宫出血1例,子宫穿孔1例,TURP综合征2例.术后月经减少情况:0型黏膜下肌瘤为100%, Ⅰ型为99.1%,Ⅱ型为94.02%,宫颈肌瘤和脱出肌瘤为100%, 多发黏膜下及壁间肌瘤为84%,子宫腺肌瘤为87%.术后痛经减轻的比例为78%,贫血治愈比例82.95%.结论 TCRM切除子宫肌瘤安全、高效,是子宫黏膜下和壁间肌瘤的首选治疗方法.

Objective To study the technique and effect of transcervical resection of myoma (TCRM)in treatment of hysteromyoma. Methods 962 women suffering type 0 hysteromyoma (n=281), 316 type 1 hysteromyoma (n=316), type 2 hysteromyoma (n=282), submucous and intramural myoma (n=34), cervical myoma (n=11), prolapse myoma (n=23), and adenomyoma (n=15) underwent TCRM with “five-step technique”, monitored by B-ultrasound or laparoscopy, Follow-up lasted more than 6 months. Results The primary operation successful rate was 99.77%. The mean size and depth of uterus were 7.44±1.3 gestation weeks and (8.31±1.43) cm, the diameter of the biggest myoma was 7.2 cm. The mean weight of the resected tissues was (22.63±31.41) g, and the mean operation time and blood loss during the operation were 32.50±172.72 minutes and (7.75±19.49) ml. No transfusion was needed. The complications included postoperative fever (3 cases), uterine bleeding (1 case), uterine perforation (1 case), and TURP syndrome (2 cases). Postoperative scanty menstrual rate was 100% in the type 0 hysteromyoma group, 99.1% in the type Ⅰ hysteromyoma group, 94.02% in the type Ⅱ hysteromyoma group, 100% in the cervical myoma and prolapse myoma group, 84% in the multiple myoma and intramural myoma group, and 87% in the adenomyoma group respectively. The alleviation rates of dysmenorrhea and anemia were 78% and 82.95% respectively. Those who have severe complications of internal medicine showed obvious improvement. The residual myoma of 2 cases were resected during the secondary operation 9 days and 3 months after the primary operation. 455 cases (52.17%) resumed their work in 1 month postoperatively. 32 living infants were delivered. Conclusion Safe and highly effective, TCRM can be the first choice in treatment of submucous and intramural hysteromyoma.