宫腔镜电切术治疗子宫黏膜下肌瘤300例临床分析

Hysteroscopic excision of submucous myoma:Analysis of 300 cases

目的探讨宫腔镜电切手术治疗子宫黏膜下肌瘤的安全性和有效性。方法回顾性分析2010年1月至2016年6月本院收治的300例子宫黏膜下肌瘤患者的临床资料,其中0型99例,Ⅰ型134例,Ⅱ型67例,均行宫腔镜电切手术,观察患者术中情况以及术后治疗效果。结果术前205例(68.3%)患者有异常子宫出血(AUB)的表现,贫血患者77例(25.7%),74例(24.7%)患者表现为自然流产,99例(33.0%)患者表现为不孕。300例手术中,手术时间为(22.2±7.0)min,术中出血(12.9±4.3)ml,0型和Ⅰ型子宫黏膜下肌瘤一次成功切除,有4例Ⅱ型子宫黏膜下子宫肌瘤行二次电切术。无并发症发生。术后随访1~2年,成功随访152例,其中术前有AUB表现的患者111例,术后月经改善91例(82.0%);有生育要求患者92例,术后妊娠47例(63.0%)。结论宫腔镜电切术治疗子宫黏膜下肌瘤安全可靠,是子宫黏膜下肌瘤治疗的首选手术方法,该手术可以改善患者月经以及促进生殖预后,在临床上值得进一步的推广应用。

Objective To investigate the safety and efficacy of hysteroscopic excision of submucous myoma.MethodsClinical data of 300 patients with submucous myoma admitted between January 2010 and June 2016 in our hospital were retrospectively analyzed.All patients were treated by hysteroscopic excision of submucous myoma, with 99 cases with type 0, 134 cases with type I and 67 cases with type II.The effect of intraoperative and postoperative treatments were compared.ResultsPreoperative evaluation revealed 205 cases （68.3%） with abnormal uterine bleeding （AUB）, 77 （25.7%） cases with anemia, 74 cases （24.7%） with spontaneous abortion, and 99 cases （33.0%） with infertility.The operation duration was （22.2±7.0） min and intraoperative hemorrhage was （12.9±4.3） ml.All patients with type 0 and type I submucous myoma were successfully excised, but 4 cases with type II needed a second hysteroscopic excision.No complications were encountered.In the 1-2 years of postoperative follow-up, 152 cases were followed up successfully.Of the 111 cases with preoperative AUB, postoperative menstruation improved in 91 cases （82.0%）.Of 92 cases with infertility, postoperative pregnancy were successful in 47 cases （63.0%）.ConclusionHysteroscopic excision of submucous myoma was safe and reliable for patients and improved menstruation and reproductive outcomes.Strict surgical indications could enhance the quality of surgery.It is a preferred and recommended surgical method for the treatment of submucosal myoma.