倾向得分匹配法对两种方法治疗子宫肌瘤的疗效再评价及复发相关因素分析

Reevaluation of the efficacy of two methods in the treatment of uterine fibroids using propensity score matching method and analysis of the recurrence related factors

目的:评价腹腔镜子宫肌瘤剔除术(laparoscopic myomectomy,LM)与开腹子宫肌瘤剔除术(transabdominal myomectomy,TAM)的疗效,分析其术后复发的危险因素。方法:回顾分析2015年8月至2016年3月行LM与TAM的119例患者的临床资料,其中72例行LM,47例行TAM。肌瘤位置为肌壁间、浆膜下。采用倾向得分匹配法(propensity score matching,PSM)均衡组间混杂因素的影响,比较匹配后两组患者术后情况,并分析术后复发的危险因素。结果:经PSM获得43对患者,基线资料组间分布均衡。LM组住院时间、术后疼痛评分、术后排气时间均优于TAM组,差异有统计学意义(P<0.05);两组术中出血量、2年复发率差异无统计学意义。术后2年共26例复发,logistic回归分析显示,肿瘤数量≥4是术后肿瘤复发的危险因素。结论:应用PSM可有效提高非随机资料组间协变量的均衡性,并对子宫肌瘤切除术的疗效做出正确评价。LM患者能更快地从手术中恢复,术后2年内复发率与TAM基本一致;肿瘤数量≥4是术后肿瘤复发的危险因素。

Objective： To evaluate the efficacy of laparoscopic myomectomy（ LM） and transabdominal myomectomy（ TAM）,and to analyze the risk factors of postoperative recurrence.Methods： Clinical data of 119 patients who underwent LM or TAM from Aug.2015 to Mar.2016 were retrospectively analyzed,including 72 patients with LM and 47 patients with TAM.The location of myoma was intramural and subserous.Propensity score matching（ PSM） was used to balance the influence of intergroup confounding factors,and the postoperative conditions of the two groups were compared,and the risk factors of postoperative recurrence were analyzed.Results： Fortythree patients were obtained after PSM,and all baseline data were evenly distributed between the two groups.The time of hospitalization,visual analogue score of postoperative pain and postoperative exhaust time of group LM were superior to those of group TAM,and the difference was statistically significant（ P0.05）.There was no significant difference in intraoperative bleeding or 2-year recurrence rate after operation between the two groups. There were 26 relapses in 2 years after operation. Logistic regression analysis showed that the number of tumors ≥4 was a risk factor for postoperative recurrence. Conclusions： The application of PSM can effectively improve the balance of covariates among non-randomized data groups,thus can make a correct evaluation of the efficacy of hysteromyomectomy.The patients with LM can recover faster from the operation,and the recurrence rate within 2 years after the operation is basically the same as TAM,and the number of tumors ≥4 is the risk factor for postoperative tumor recurrence.