Ⅱ型子宫黏膜下肌瘤术前超声评估MFM的临床意义

Evaluation of the preoperative myometrial free margin(MFM) of type Ⅱsubmucosal fibroids by transvaginal ultrasonography

目的评估超声检测子宫肌瘤假包膜到浆膜面的最短距离(myometrial free margin,MFM)在宫、腹腔镜两种术式去除Ⅱ型子宫黏膜下肌瘤中的临床应用,为临床病例选取经济有效的手术方式提供依据。方法选取2010年6月至2015年2月期间行宫腔镜(实验组)和腹腔镜(对照组)Ⅱ型子宫黏膜下肌瘤去除术的分别为103例和87例。采用回顾性的方法,记录阴道超声观察术前子宫肌瘤的直径,位置(子宫肌瘤包膜到子宫浆膜面的最短距离和到子宫黏膜面的最短距离)及肌瘤的数目、手术的时间、术中出血量、术后血红蛋白变化情况,住院时间、术后住院时间及住院费用等指标。结果术前阴道超声检测宫、腹腔镜手术的两组患者的子宫肌瘤的数目和直径比较,差异无统计学意义(P>0.05)。子宫肌瘤包膜到浆膜面的最短距离(MFM),宫腔镜组为(5.88±1.60)mm,腹腔镜组为(4.92±2.62)mm,两组比较,差异无统计学意义(P>0.05)。而两组患者子宫肌瘤包膜到子宫黏膜面的最短距离分别为宫腔镜组(2.78±2.16)mm,腹腔镜组(9.45±6.284)mm,两组差异有统计学意义(P<0.01)。宫、腹腔镜两组患者的手术时间分别为(52.32±22.48)min和(88.34±18.42)min,术中出血量分别为(20.28±36.28)m L和(48.39±32.61)m L,术前后血红蛋白差值分别为(7.98±6.20)g/L和(16.32±4.53)g/L,术后住院天数分别为(2.23±1.02)d和(5.03±1.10)d,住院费用分别为(4 989.52±988.98)元和(12 523.23±2 871.08)元,上述指标宫腔镜组均低于腹腔镜组,差异有统计学意义(P<0.01);所有病例术后组织病理均为良性子宫平滑肌瘤。结论宫腔镜子宫肌瘤电切术是Ⅱ型子宫黏膜下肌瘤的一种治疗方法,具有创伤小、失血少、恢复快、费用低等优点,对于直径<65 mm,子宫肌瘤包膜到浆膜面的最短距离5 mm的Ⅱ型子宫黏膜下肌瘤,选择宫腔镜电切术为安全有效的治疗方法。

Objective To assess the preoperative myometrial free margin（ MFM） of type Ⅱ submucousal fibroids by transvaginal ultrasonography（ TVS） that will predict the surgical methods. Methods Charts from hysteroscopic 103 cases（ TCRM,Observation group） and laparoscopic 87 cases total laparoscopic myomectomy（ TLM）,Control group myomectomies were performed between June2010 and February 2015. We reviewed for preoperative TVS findings. Predictors included myoma number,diameter and the location of type Ⅱ submucosal fibroids at preoperative TVS. The surgical time,intraoperative bleeding,length of stay and hospital costs were recorded after surgery. Results There is no difference between the two groups in the myma number. The mean length of myometrial free margin was（ 5. 88 ± 1. 60） mm,the length of the fibroids pseudocapsule to uterine mucosa was（ 2. 78 ± 2. 16） mm,surgical time was（ 52. 32 ± 22. 48） min,blood loss was（ 20. 28 ± 36. 28） m L,the difference between the hemoglobin after and before surgery was（ 7. 98 ±6. 20） g / L,length of stay after surgery was（ 2. 23 ± 1. 02） d and the hospital cost was（ 4 989. 52 ± 988. 98） yuan in the group of hysteroscopic myomectomies. Meanwhile,in the group of laparoscopic myomectomies the mean length of myometrial free margin was（ 4. 92± 2. 62） mm,the length of the uterine fibroids psuedocapsule to uterine mucosa was（ 9. 450 ± 6. 284） mm,surgical time was（ 88. 34 ± 18. 42） min,blood loss was（ 48. 39 ± 32. 61） m L,The difference between the hemoglobin after and before surgery was（ 16. 32± 4. 53） g / L,length of stay after surgery was（ 5. 03 ±1. 10） d and the hospital cost was（ 12 523. 23 ± 2871. 08） yuan. Conclusion Hysteroscopic myomectomy of type Ⅱ submucous fibroids may be performed successfully and safely under the condition of MFM no more than 5 mm and the diameter of fibroid less than 65 mm.