摘要
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.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2005年第3期173-176,共4页
National Medical Journal of China