子宫肌瘤剔除术后残留复发的相关危险因素

Relative risk factors of residual or recurrence after myomectomy

目的分析子宫肌瘤剔除术后残留复发的相关危险因素。方法随机选择2007年1月-2016年12月在常州市新北区魏村卫生院及常州市妇幼保健院就诊,确诊为子宫肌瘤,行子宫肌瘤剔除术的124例患者,将其分为开腹子宫肌瘤剔除术(TAM)组(63例)、腹腔镜下子宫肌瘤剔除术(LM)组(50例)和宫腔镜电切术组(11例)。收集患者资料,包括年龄,术前合并症状,妊娠史,子宫肌瘤的位置、数目、直径、病理类型,术后妊娠情况及残留复发情况,评估这些因素和子宫肌瘤残留复发的相关性。结果所有患者均顺利完成手术,手术时间43~195 min,住院时间4~7 d,术中出血量37~289 ml。术后子宫肌瘤残留与复发35例(28.23%)。子宫肌瘤数目和直径不同的患者术后残留复发发生率比较差异有统计学意义(P<0.05)。Logistic多因素回归分析显示:子宫肌壁间肌瘤、子宫肌瘤数目>4个、奇异型平滑肌瘤、富于细胞型平滑肌瘤是子宫肌瘤剔除术后残留复发的影响因素。结论子宫肌壁间肌瘤、子宫肌瘤数目>4个、奇异型平滑肌瘤、富于细胞型平滑肌瘤是子宫肌瘤剔除术后残留复发的影响因素。

Objective To analyze the related risk factors of residual or recurrence after myomectomy. Methods A total of 124 patients diagnosed as hysteromyoma definitely in Wei Village Health Center of New North District of Changzhou city and Changzhou Municipal Maternal and Child Health Care Hospital from January 2007 to December 2016 were randomly selected,then myomectomy was performed.All the patients were divided into transabdominal myomectomy（ TAM） group（ 63 patients）,laparoscopic myomectomy（ LM） group（ 50 patients）,and transcervical resection of myoma（ TCRM） group（ 11 patients）. The general data of patients was collected,including age,preoperative symptoms,pregnancy history,location,number,diameter,pathological types of uterine fibroids,postoperative pregnancy status,residual and recurrence. The correlations between these factors and residual or recurrence of uterine fibroids were evaluated.Results Myomectomy was completed successfully in all the patients,the operation time was 43-195 minutes,the hospitalization time was 4-7 days,the amount of intraoperative bleeding was 37-289 ml. The incidence rate of residual or recurrence after myomectomy was 28. 23%（ 35 patients）. There were statistically significant differences in the incidence rate of residual or recurrence after myomectomy among the patients with different numbers and diameters of uterine fibroids（ P 0. 05）. Logistic multivariate regression analysis showed that intramural myoma,number of uterine fibroids more than 4,bizarre leiomyoma,and cellular leiomyoma were influencing factors of residual or recurrence after myomectomy. Conclusion Intramural myoma,number of uterine fibroids more than 4,bizarre leiomyoma,and cellular leiomyoma are influencing factors of residual or recurrence after myomectomy.