宫腔镜诊治子宫黏膜下肌瘤的价值探讨

Value of hysteroscopy in diagnosis and treatment of subumcosal myoma of uterus

目的讨论宫腔镜诊治子宫黏膜下肌瘤的价值。方法 40例行宫腔镜子宫肌瘤切除术(TCRM)患者,观察分析患者术中、术后以及患者满意情况。结果宫腔镜术中证实子宫黏膜下肌瘤最终个数,单发37例(92.5%),多发3例(7.5%)。肌瘤分型:0型29例(72.5%),Ⅰ型9例(22.5%),Ⅱ型1例(2.5%), 0+Ⅰ型1例(2.5%)。手术时长10~103 min,平均手术时长(32.03±22.30)min。38例切净(95.0%),2例有残留(5.0%)。无一例出现周围脏器损伤、大出血、子宫穿孔、气体栓塞,Ⅱ型黏膜下肌瘤切除时发生经尿道前列腺电切术(TURP)综合征1例(2.5%)。术后住院时长≤7 d,平均术后住院时长(4.58±1.52)d。术后出血多1例(2.5%),继发盆腔感染2例(5.0%),无静脉血栓、宫腔粘连发生。病理报告诊断子宫平滑肌瘤34例(85.0%),子宫腺肌瘤6例(15.0%)。患者满意34例(85.0%),不满意6例(15.0%),其中包括2例(2.5%)患者未成功妊娠, 4例(5.0%)患者仍月经紊乱。结论宫腔镜诊治子宫黏膜下肌瘤准确度高、安全度高、患者满意度高,值得推广。

Objective To discuss the value of hysteroscopy in diagnosis and treatment of subumcosal myoma of uterus. Methods There were 40 patients undergoing transcervical resection of myoma(TCRM), and the intraoperative conditions, postoperative conditions, and patient satisfaction were observed and analyzed. Results The final number of submucous myoma was confirmed by hysteroscopy, 37 cases(92.5%) were single and 3 cases(7.5%) were multiple. Myoma typing: 29 cases(72.5%) of type 0, 9 cases(22.5%) of type Ⅰ, 1 case(2.5%) of type Ⅱ, and 1 case of type 0 and Ⅰ(2.5%). The operation time was 10~103 min, with average operation time as(32.03±22.30) min. 38 cases were cut clean(95.0%), 2 cases were residual(5.0%). There was no case of peripheral organ injury, massive hemorrhage, uterine perforation and gas embolism. 1 case(2.5%) of transurethral resection of prostate(TURP) syndrome occurred during type Ⅱ submucous myomectomy. The postoperative hospitalization time was ≤7 d, with average postoperative hospitalization time as(4.58±1.52) d. There was 1 more cases(2.5%) of postoperative bleeding, and 2 cases(5.0%) of secondary pelvic infection. No venous thrombosis and intrauterine adhesions occurred. 34 cases(85.0%) of leiomyoma and 6 cases(15.0%) of adenomyoma were diagnosed by pathology. 34 patients(85.0%) were satisfied, 6 patients(15.0%) were dissatisfied, including 2 patients(2.5%) who were not pregnant successfully, 4 patients(5.0%) who were still menstrual disorders. Conclusion Hysteroscopy shows high accuracy, safety, and patient satisfaction for diagnosis and treatment of subumcosal myoma of uterus, which is worthy of promotion.