宫腔镜下子宫肌瘤切除术保留假包膜与否对子宫创面愈合的影响

Whether Retaining Myoma Pseudocapsule Has Effect on the Healing of Uterine Wound of Hysteroscopic Myomectomy?

目的:分析2型子宫肌瘤(分型依据FIGO 2011)宫腔镜切除术保留假包膜与否对子宫创面愈合的影响。方法:收集2014年1月—2017年9月诊断为2型子宫肌瘤(单发,肿瘤最大径线≥2.5 cm)、通过宫腔镜下子宫肌瘤切除术一期全部切除的患者共70例,分为2组。A组术毕保留肌瘤假包膜,B组术毕切除突入宫腔的假包膜组织。记录肌瘤的大小、术前促性腺激素释放激素激动剂(Gn RHa)类药物的使用情况、手术时间、术中出血情况、术中及术后并发症情况。分别于术后1和3个月进行宫腔镜检查,观察并比较2组患者宫腔创面的愈合情况和宫腔粘连情况。结果:2组患者的平均年龄、肌瘤的平均最大径线、术前Gn RHa类药物使用率比较,差异无统计学意义(P>0.05);A组平均手术时间为(33.3±12.3)min(17~65 min),B组平均手术时间为(32.7±12.1)min(18~70 min),2组比较差异无统计学意义(t=0.195,P=0.846)。A组术中平均出血量为(26.4±16.3)m L(10~50 m L),B组平均术中出血量为(26.7±15.8)m L(10~50 m L),2组比较差异无统计学意义(t=-0.074,P=0.941);术后1个月复查,A组(2/35)、B组(7/35)宫腔粘连发生率比较,差异无统计学意义(5.71%vs.20.00%,χ~2=3.188,P=0.074);术后3个月复查,B组(4/35)宫腔粘连发生率高于A组(0/35),差异有统计学意义(11.43%vs.0,P=0.039)。结论:在宫腔镜下子宫肌瘤切除术的切割过程中应注意保护并保留假包膜,术后及时宫腔镜二次探查,预防宫腔粘连的发生。

Objective:The aim of this study was to evaluate whether retaining myoma pseudocapsule has effect on the healing of uterine wound of hysteroscopic myomectomy for symptomatic type 2 uterine myoma(according to classification for myoma of FIGO, 2011). Methods:From January 2014 to September 2017 in Fuxing hospital, cases of type 2 uterine myoma(single, larger than 2.5 cm) were collected for heaving uterine bleeding and were performed one-step hysteroscopic myomectomy. A total of 70 cases were divided into 2 groups, the myoma pseudocapsule were retained after myomectomy for Group A(35 cases), the myoma pseudocapsule protruding into the uterine cavity were removed for Group B(35 cases). The following medical data were recorded: the age of patients, the size of the myoma, pre-operative treatment by Gn RH analogue,operation time, blood loss during the operation, surgical complications. At 1 and 3 months after the operation, second-look hysteroscopy was performed to observe and compare the uterine cavity wounds healing condition of the two groups. Results:There is no significant difference of patients′ age, size of the myoma and the use of pre-operative Gn RHa between the two groups; the mean operation time of group A was(33.3 ±12.3) min(range 17~65 min), the operation time of group B was(32.7 ±12.1) min(range 18~70 min), there was no significant difference(t=0.195,P=0.846). The mean volume of intra-operative blood loss of group A was(26.4±16.3) m L(10~50 m L), the mean volume of intra-operative blood loss of group B was(26.7 ±15.8) m L(10~50 m L), there was no statistical difference(t=-0.074,P=0.941); the incidence of intrauterine adhesions after 1 months was5.71%(2/35) in group A and 20.00%(7/35) in group B, there was no significant difference( χ2=3.188,P=0.074); the incidence of intrauterine adhesions after 3 months was 0(0/35) in group A and 11.43%(4/35) in group B, there was significant difference(P =0.039). Conclusions:Myoma pseudocapsule should be protected and retained for hysteroscopic myomectomy surgery.Second-look hysteroscopy is important for prevention intrauterine adhesion after hysteroscopic myomectomy.