宫腔镜下3型子宫肌瘤切除术可行性及生殖预后分析

Hysteroscopic Resection of Type 3 Myoma: Feasibility and Postoperative Reproductive Outcome

目的:分析3型子宫肌瘤(分型依据FIGO 2011)宫腔镜切除术的可行性以及患者生殖预后情况。方法:收集2013年1月—2017年10月诊断为3型子宫肌瘤(单发,直径大于2.5 cm)且行宫腔镜下子宫肌瘤切除术的患者共计59例。记录患者的症状、3型子宫肌瘤的大小、术前促性腺激素释放激素激动剂(GnRHa)类药物的使用情况、术前肌瘤距子宫浆膜层的距离、手术时间、术中出血情况、术后肌层恢复厚度,术中及术后并发症情况。有生育要求患者术后1个月及3个月宫腔镜检查复查情况,无生育要求者术后1个月及3个月门诊就诊复查症状改善情况。电话随访达术后12个月以上患者的术后妊娠情况。结果:患者年龄26~46岁,平均(37.1±4.8)岁,肌瘤的最大径线2.5~7.0 cm,平均(4.2±1.0)cm。一期手术完成率89.8%,手术时间(49.4±16.4)min(20~105 min),术中出血量10(10,20)mL(5~200 mL),术前肌瘤距子宫肌层厚度1~5.7 mm,平均(3.3±1.1)mm,术后瘤窝距子宫肌层厚度4.9~11.3mm,平均(8.9±1.3)mm。所有患者术中及术后均未发生子宫穿孔、大出血、TURP综合征和感染等并发症。术后症状均得到改善。有生育要求的患者术后3个月复查宫腔镜检查均无宫腔粘连发生,术后1年内妊娠率达73.3%(11/15),术后妊娠平均时间(6.0±3.3)个月。结论:对于3型子宫肌瘤,B型超声引导下宫腔镜手术安全、可行;术后恢复快,短期内可妊娠,但需由有经验的医生来完成。

Objective:To evaluate the feasibility of the hysteroscopic resection of symptomatic type 3 myoma and the reproductive outcome after operation.Methods:Fifty-nine patients with type 3 myoma(>25 mm,single)who underwent an hysteroscopic resection from January 2013 to October 2017 in Fuxing hospital were enrolled.The following medical data were recorded:symptoms,size of the type 3 myoma,preoperative treatment with GnRH analogue and length of surgery.The distance between the edge of myoma and the serosal layer before surgery and the thickness of the uterine wall of myoma side after hysteroscopic myomectomy were measured immediately.In the one month and three months after operation,the hysteroscopic reexamination was performed for the patients who had childbirth plan,and the symptomatic reexamination was for the patients without birth demand.The postoperative menstrual condition and pregnancy outcome were followed up for 12 months by the telephone follow-up.Results:The patient age was 37.1±4.8(26-46)years.The surgical time was 49.4±16.4(20-105)min,and there was no surgical complication.The one-step hysteroscopic myomectomy was performed for 53 cases(89.8%),and the volume of blood loss was 10(10,20)(5-200)mL.The distance between the edge of myoma and the serosal layer before surgery was 3.3±1.1(1-5.7)mm,and the thickness of the uterine wall of myoma side immediately after hysteroscopic myomectomy was 8.9±1.3(4.9-11.3)mm.The improvement rate of postoperative menstruation was 100%,and the postoperative pregnancy rate was 73.3%(11/15).Conclusions:Hysteroscopic resection for type 3 myoma under ultrasound guidance is safe as a potential alternative to traditional surgery.The postoperative reproductive outcome is good if it is performed by an experienced surgeon.