子宫肌瘤剔除术后复发的影响因素分析

Analysis of influencing factors of residual recurrence after hysteromyomectomy

目的:研究子宫肌瘤剔除术后复发的影响因素。方法:回顾性分析2017年8月至2018年8月我院经子宫肌瘤剔除术治疗的105例患者的临床资料,设计一般资料调查表,通过患者病历资料,记录患者的年龄、体质量、肌瘤数量、肌瘤最大径、肌瘤生长部位(浆膜下、肌壁间以及黏膜下)、术前合并症状、术后肌瘤残留、残留患者后续是否进行药物治疗、手术方式(开腹、腹腔镜、经阴道)。经单因素、多因素分析子宫肌瘤剔除术后复发的影响因素。结果:术后3个月随访,经B超检查发现,残留肌瘤患者4例,残留率3.48%,残留个数1-4个;术后6个月随访,经B超检查发现,肌瘤复发10例,复发率8.70%。与未复发组相比,复发组年龄<40岁、肌瘤数量≥4个、肌瘤最大径≥8 cm、术后肌瘤残留及残留患者后续没有进行药物治疗的患者占比较高(P<0.05);经非条件多项Logistic回归分析,年龄(<40岁)、肌瘤数量(≥4个)、肌瘤最大径(≥8 cm)、术后有肌瘤残留以及残留患者后续没有进行药物治疗是子宫肌瘤剔除术后复发的危险因素(OR>1,P<0.05)。结论:经子宫肌瘤剔除术治疗的患者术后发生复发可能受到年龄、肌瘤数量、肌瘤最大径、术后有肌瘤残留以及残留患者后续没有进行药物治疗等因素影响,故临床需积极防治上述高危因素。

Objective:To study the influencing factors of residual recurrence after hysteromyomectomy.Methods:The clinical data of 105 patients who underwent myomectomy in our hospital from August 2017 to August 2018 were retrospectively analyzed.The general information questionnaire was designed.The patient's age,body weight,number of myoma,maximum diameter of myoma,growth site of myoma(subserous,intramural and submucosal),preoperative symptoms,postoperative myoma residue and residual,the follow-up drug treatmen and surgical methods(laparotomy,laparoscopy,transvaginal)were recorded through the patient's medical records.The influencing factors of recurrence after myomectomy were analyzed by univariate and multivariate analysis.Results:After 3 months of follow-up,4 cases of residual myoma were found by B-ultrasound examination,the residual rate was 3.48%,and the number of residual myoma was 1-4.After 6 months follow-up,B-ultrasound examination found that 10 cases of leiomyoma recurrence,the recurrence rate was 8.70%.Compared with the non recurrence group,the patients with age<40 years old,the number of fibroids≥4,the maximum diameter of fibroids≥8 cm,postoperative residual fibroids and no subsequent drug treatment accounted for a higher proportion in the recurrence group(P<0.05).Unconditional multiple logistic regression analysis confirmed that age(<40 years old),the number of leiomyomas(≥4),the maximum diameter of leiomyoma(≥8 cm),postoperative residual leiomyoma and no follow-up drug treatment were risk factors for recurrence after myomectomy(OR>1,P<0.05).Conclusion:The recurrence of patients after hysteromyomectomy may be affected by age,the number of fibroids,the maximum diameter of fibroids,the presence of residual fibroids after operation and the absence of drug treatment in patients with residual fibroids.