268例子宫肌瘤临床诊疗分析

The clinical analysis of 268 cases with uterine leiomyomas

目的：探讨子宫肌瘤患者临床特点、肌瘤生物学特征与手术方式的关系，为子宫肌瘤的个性化诊治提供参考。方法选择江苏盛泽医院2009年1月至2013年11月收治的子宫肌瘤行手术治疗的268例患者临床资料，对子宫肌瘤患者临床特点、肌瘤生长方式、手术方式的选择进行回顾性分析。结果268例子宫肌瘤术后标本直径0.8~19 cm，单发肌瘤107例（39.93%），多发肌瘤161例（60.07%）；肌壁间肌瘤210例（78.36%），浆膜下与黏膜下肌瘤53例（19.78%），子宫颈肌瘤5例（1.87%）。术后病理结果有58例肌瘤发生部分变性，变性类型包括富于细胞型子宫肌瘤、子宫肌瘤伴红色变性、玻璃样变性、囊性变、黏液样变、脂肪变、钙化。72例患者行阴式手术治疗，其中21例子宫肌瘤切除术，31例子宫全切除术，20例子宫次全切除术；196例行经腹手术治疗，其中79例经腹子宫肌瘤切除术，87例全子宫切除术（同时行双侧附件切除21例），30例次全子宫切除术。结论肌瘤切除术适合于年轻、尚未生育需保留生育功能、患者要求保留子宫者；如患者无生育要求、肌瘤较大或较多，或疑有恶变者应行子宫切除术；选择一种最适合患者的术式是确保手术成功的关键。

Objective To analyze the correlation between operative manner and the clinical characteristics, biological features of the uterine leiomyomas, to guide the individualized diagnosis and treatment of uterine leiomyomas. Methods Drom January 2009 to November 2013,the clinical data of 268 patients with uterine leiomyoma in Shengze hospital were collected. The patients ’ clinical characteristics,growth manners of uterine leiomyomas,the choice of operative manner were retrospectively analyzed. Results The diameter of uterine leiomyomas specimens of the 268 patients ranged from 0. 8 cm to 19 cm. 107 patients were of single tumor （39. 93%）,and 161 patients were of multiple tumors（60. 07%）. 210 cases were intramural myoma（78. 36%）,53 cases were subserosal and submucous myoma （ 19. 78%）,5 cases were cervical myoma （ 1. 87%）. The postoperative pathological results showed that 58 cases of leiomyomas had degenerated. The types of degeneration included cellular leiomyoma of the uterus,red degeneration,hyaline degeneration,cystic degeneration,mucoid degeneration,fatty degeneration,and calcification. 72 patients received transvaginal operation,including 21 cases of uterine leiomyomas resection,31 cases of total hysterectomy,20 cases of subtotal hysterectomy. 196 patients received transabdominal operation,including 79 cases of uterine leiomyomas,87 cases of total hysterectomy（21 cases received bilateral accessory resection at the same time ） and 30 cases of subtotal hysterectomy resection. Conclusion Myomectomy was suitable for young,childless and with fertility requirements patients,or the patients with request of retaining uterus. Hysterectomy was suitable for the patients with large or multiple fibroids and without fertility requirements,or the cases whose leiomyomas being suspected malignant. To select suitable operative manner for patient was the key to ensure the success of operation.