子宫肌瘤术后复发及相关因素分析

A clinical analysis on the situation and related risk factors of recurrence of uterine myoma after myomectomy

目的探讨子宫肌瘤切除术后复发的相关危险因素,以期降低肌瘤术后复发。方法回顾性研究以子宫肌瘤为第一手术指征行子宫肌瘤切除术的264例患者的临床资料,随访其术后复发等情况及肌瘤复发率,对与肌瘤复发可能相关的因素进行单因素和多因素分析。结果 264例平均随访(42.20±16.23)个月,复发84例(31.82%),复发时间距手术平均(39.46±13.77)个月。肌瘤数目、随访时间、初潮年龄、术后是否采用相关药物进行后续治疗是术后肌瘤复发的相关因素(P<0.05),其中肌瘤数目、随访时间和初潮年龄是肌瘤复发的主要危险因素;最大肌瘤的直径、肌瘤变性与否、手术时年龄、手术方式、体重指数、避孕方式、术前平素月经周期和经期的长短、民族及家族史与肌瘤复发无明显相关性(P>0.05)。结论肌瘤数目、随访时间和初潮年龄是子宫肌瘤切除术后复发的主要危险因素,术前应严格选择适应证,对具有主要复发危险因素者尤应更加谨慎。

Objective To analyze the related risk factors of recurrence of uterine myoma after myomectomy.Methods 264 cases who was diagnosed as uterine myoma and undergoing myomectomy were analyzed with retrospective cohort study.All the patients were followed up regularly after operation,and the postoperative recurrence rate was calculated.Univariate and multivariate analysis were performed for possible factors related to recurrence.Results The average time of follow-up was 42.20±16.23 months.Recurrence was found in 84 cases,and the cumulative rate of recurrence was 31.82%.The recurrence was 39.46±13.77 months away from the operation.The number of myoma found by ultrasonography or during operation,the follow-up time,the age of menarche and whether taking related medicine or not after operation were related factors of recurrence（P0.05）.The numbers of myoma found during operation,the follow-up time and the menarche age came out to be the main risk factors of the recurrence of myoma by way of multivariate analysis.Other clinical features and the characteristics of cases,such as age,family history,way of operation,the diameter of the largest myoma found by ultrasonography or during operation and myoma degeneration were not related to the recurrence rate（P0.05）.Conclusion The numbers of myomas found out during operation,the follow-up time and the menarche age came out to be the main risk factors of the recurrence of myoma.Indications of myomectomy should be strictly chosen and those patients with major risk factors of recurrence in particular should be paid more precaution.