宫腔镜下单极电切割和激光治疗子宫粘膜下肌瘤的比较研究

The Comparison on the Effect of Transcervical Resection of Myoma Between Hysteroscopic Electrotomy and Laser Surgery

目的:评价宫腔镜下单极电切割手术治疗子宫粘膜下肌瘤的有效性和安全性。方法:将568例子宫粘膜下肌瘤患者分为宫腔镜下单极电切割治疗318例(治疗组)和激光手术治疗250例(对照组)。比较分析两组的治疗时间,膨宫液用量和治疗效果。结果:治疗组318例中0型及I型子宫粘膜下肌瘤均一次手术成功,两组手术后均无严重的并发症。治疗组平均手术时间10分钟(5～25分钟),平均膨宫液用量600ml(300～1200ml);对照组分别为25分钟(5～80分钟),1106ml(300～3300ml)。治疗组总的术后满意率为94.3%(300/318),0型、I型术后满意率为100%;对照组分别为68.8%(P<0.005),73.9%(P<0.005)。结论:宫腔镜下单极电切割手术治疗子宫粘膜下肌瘤是一种有效而安全的方法,与激光手术治疗比较,手术时间缩短,手术成功率提高。

Objective: To evaluate the efficiency effec t and safety of hysteros copic monopolar electrotomy in the treatment of various uterine submucous myoma. Methods: 318 cases with submucous myoma in the study gr oup were treated by hysteroscopic monopolar electrotomy. Among them were 220 cas es of type 0, 60 cases of type I, and 38 cases of type II submucous myoma. Control group included 170 cas es of type 0, 60 cases of type I, and 20 cases of type II submucous myoma treate d by hysteroscopic laser surgery. All the cases were followed-up in 3～36 months after transcervical resection of myoma(TCRM). The efficacy and safety of the tr eatment were evaluated combined by pelvic examination, transvaginal ultrasound s canning, and patient's main complaint. Results: All surg eries were successfully done. The mean depth of uterine cavity was 8.5cm (7.5～12cm). In the study group , the mean surgery time was 10 min( 5～25 min) vs 25min(5～80 min) of control g roup, the mean consumption of 5% glucose solution was 600ml(300～1200ml) vs 1106 ml(300～3300ml)in control group. No severe complication occurred peri- and po st-operation. The total satisfaction rate in study group got 94.3% vs 68.8%(172/ 250) in control group and it reached 100% for 0 and I type submucos myoma vs 73. 9%(170/230) in laser group during follow-up. 12 (60%) cases with infertility got pregnant after surgery. There were significant difference between two groups in surgery time, medium liquid consumption and surgery effic acy(P<0.005). Conclusions: Hysteroscopic myomectom y with m onopolar electrotomy provides a safe, effective method for treating submucous my oma. [