FIGO 3型子宫肌瘤经宫腔镜电切手术的临床探索研究

Clinical study of hysteroscopical electroresection of FIGO type 3 myoma

目的探索国际妇产科联盟(FIGO)3型子宫肌瘤经宫腔镜电切手术的临床效果和可行性。方法回顾性分析2019年1月至2021年10月在复旦大学附属妇产科医院接受宫腔镜下单发FIGO 3型子宫肌瘤电切手术患者的临床资料,记录患者的临床症状、肌瘤大小、位置、手术时间、术中出血量、手术并发症、术后随访情况,并随访术后是否有生育计划、是否妊娠及后续的妊娠结局。结果共有35例FIGO 3型子宫肌瘤患者纳入本研究,年龄为(36.6±4.7)岁,肌瘤最大径线为(4.0±1.2)cm(范围:2.0~5.8 cm)。手术一次完成率86%(30/35),手术时间为(41±15)min(范围:20~65 min),术中出血量(24±18)ml(范围:5~150 ml)。所有患者术中及术后均未发生子宫穿孔、大出血、液体超负荷、感染等并发症。术前月经量增多者有20例,宫腔镜下电切3型子宫肌瘤对月经量增多的治愈率为75%(15/20),缓解率为20%(4/20),有效率为95%(19/20)。有生育要求的患者共24例,随访时间(14.5±6.8)个月,术后1年内妊娠率达79%(19/24),宫腔镜手术至妊娠的间隔时间为(5.8±3.4)个月;已经完成妊娠分娩者15例,其中10为阴道分娩,5例剖宫产术分娩,无一例发生子宫破裂。结论经宫腔镜可有效电切3型子宫肌瘤,有助于减少月经量,手术微创,术后恢复快,术后短期内可妊娠,有利于生殖预后,但需由有经验的宫腔镜医师进行。

Objective To analyze the clinical application and to evaluate the efficiency of hysteroscopical electroresection of International Federation of Gynecology and Obstetrics(FIGO)type 3 myoma.Methods The clinical data of patients who underwent hysteroscopical electroresection single FIGO type 3 myoma in Obstetrics and Gynecology Hospital of Fudan University from January 2019 to October 2021 were collected retrospectively.The clinical symptoms,myoma size,location,operation time,intraoperative bleeding,surgical complications and postoperative follow-up were recorded,and the subsequent pregnancy outcomes were followed-up.Results Totally 35 patients with FIGO type 3 myoma were included in this study.The average age was(36.6±4.7)years old,the diameter of myoma was(4.0±1.2)cm(range:2.0-5.8 cm).The rate of complete resection of myoma in one operation was 86%(30/35),the average operation time was(41±15)minutes(range:20-65 minutes),and the average intraoperative bleeding was(24±18)ml(range:5-150 ml).No complications such as uterine perforation,massive hemorrhage,hyperhyderation syndrome and infection occurred in all patients perioperation.There were 20 cases with significant increase of menstruation before operation,the cure rate and effective rate of hysteroscopical electroresection of FIGO type 3 myoma were 75%(15/20)and 95%(19/20).There were 24 patients with fertility requirements,their average follow-up time was(14.5±6.8)months,the pregnancy rate within 1 year after operation was 79%(19/24),and the average postoperative pregnancy time was(5.8±3.4)months.There were 15 cases who had completed delivery after operation,including 10 cases of vaginal delivery and 5 cases of cesarean section,and none of them had uterine rupture.Conclusions Hysteroscopy could effectively resect FIGO type 3 myoma.Hysteroscopical electroresection of FIGO type 3 myoma is minimally invasive with rapid postoperative recovery and could achieve pregnancy in a short time,which is not only helpful to reduce the amount of menstruation,but also beneficial for the prognosis of fertility.It should be carried out by the experienced hysteroscopists.