宫腔镜双极汽化电切治疗黏膜下子宫肌瘤456例分析

Hysteroscopic Resection with Dipolar Electrodes for Uterine Submucous Myoma:Report of 456 Cases

目的探讨宫腔镜双极汽化电切黏膜下子宫肌瘤的安全性和疗效。方法1998年1月～2007年12月经宫腔镜联合B超诊断为黏膜下子宫肌瘤456例,其中0型241例,Ⅰ型138例,Ⅱ型77例,肌瘤大小:1.0～2.0cm341例,2.1～4.0cm86例,4.1～6.0cm29例,行宫腔镜下双极汽化电切术,341例<2cm肌瘤经微型电极切割,115例>2cm肌瘤应用环形电极切割(其中16例B超监护下完成手术)。结果手术时间9～55min,(32.9±16.7)min;切下组织重量5～55g,(30.2±8.2)g;出血量5～100ml,(48.1±12.7)ml。无术中、术后并发症。术后3个月随访431例(94.5%),经期缩短,经量减少;5例(1.1%)有部分残留肌瘤,均为Ⅱ型子宫肌瘤。术后24个月42例有生育要求者15例术后妊娠,206例贫血术后贫血得到纠正,血红蛋白均升至正常范围;81例痛经者,42例症状消失,19例症状较术前明显改善,20例无变化。结论宫腔镜双极汽化电切处理黏膜下子宫肌瘤安全、有效。

Objective To determine the efficacy and safety of hysteroscopic resection with dipolar electrodes for submucous myoma of the uterus. Methods By hysteroscopy combined with B-ultrasonography, totally 456 cases of submucous myoma of the uterus were confirmed in our hospital from January 1998 to December 2007. Among the patients, 241 cases showed type 0, 138 patients were type I , and 77 cases were type II . In 341 of the cases, the myoma sized 1.0 to 2.0 in diameter, 86 cases from 2.1 to 4.0 in diameter, and the other 29 cases had the myoma ranged from 4.1 to 6.0 cm in diameter. Hysteroseopic resection with dipolar electrodes were performed on all the cases, among which microelectrode was used in 341 patients, and ring electrode was employed in 115 cases. Results The operation time ranged from 9 to 55 rain with a mean of （32.9 ± 16.7） rain. The removed tissues weighed （30.2±8.2） g in average （ranged from 5 to 55 g）. During the operation, the patients had 5 to 100 ml blood loss [mean, （48.1± 12.7） ml]. No complications occurred during and after the operation. The patients were followed up for three months, during which 431 （94.5%） showed reduced menstruation and decreased menstrual blood loss, only 5 patients （1. 1%, all were type II ） had residual myoma. In this series, totally 42 patients wished pregnancy, 15 of them became pregnant in 24 months postoperation. After the treatment, anemia was corrected in 206 patients with the level of Hb increased to a normal range; before the operation, 81 patients had menstrual pain, 42 of them were relieved and 19 were improved by the operation, while the other 20 showed no changes in the symptoms. Conclusion Hysteroscopic resection with dipolar electrodes is safe and effective for uterine submucous myoma.