围绝经期子宫肌瘤患者手术方式和手术路径选择的影响因素

Factors influencing surgical methods and paths selection for perimenopausal patients with uterine myoma

目的 探讨围绝经期子宫肌瘤患者手术方式和手术路径选择的影响因素。方法 回顾性分析2 040例围绝经期子宫肌瘤患者的临床资料,按照手术方式分为保留子宫组(577例)和切除子宫组(1 463例),按照手术路径分为开腹手术组(913例)、腔镜手术组(1 098例)和经阴道手术组(29例)。分析手术方式和手术路径的独立影响因素。结果 多因素logistic回归分析结果显示,年龄≥50岁、合并中重度贫血(血红蛋白≤90 g/L)、子宫肌瘤多发(个数≥2个)、子宫肌瘤直径≥5 cm、合并子宫腺肌症/子宫内膜异位症、合并子宫内膜简单型/复杂型增生、有子宫肌瘤手术史和已生育是选择切除子宫的独立危险因素(P<0.05)。子宫肌瘤多发、子宫肌瘤直径≥5 cm、子宫肌瘤位于宫颈/阔韧带和合并子宫腺肌症/子宫内膜异位症是选择开腹手术的独立危险因素(P<0.05)。结论 年龄较大、子宫肌瘤多发、子宫肌瘤过大和伴有合并症等是选择子宫切除的影响因素,而子宫肌瘤多发、子宫肌瘤过大、位于特殊部位和合并子宫腺肌症/子宫内膜异位症是选择开腹手术的影响因素。

Objective To analyze the factors influencing surgical methods and paths selection for perimenopausal patients with uterine myoma.Methods The clinical data of 2040 perimenopausal patients with uterine myoma were retrospectively analyzed.According to the surgical methods,the patients were divided into uterine preservation group(577 cases)and uterine resection group(1463 cases).According to the surgical paths,the patients were divided into laparotomy group(913 cases),endoscopic surgery group(1098 cases)and transvaginal surgery group(29 cases).The independent influencing factors for surgical methods and paths were analyzed.Results The results of multivariate logistic regression analysis showed that age≥50 years,moderate and severe anemia(hemoglobin<90 g/L),multiple uterine myoma(number≥2 pieces),uterine myoma with diameter≥5 cm,adenomyosis or endometriosis,simple or complex hyperplasia of endometrium,surgical history of uterine myoma,and childbearing history were the independent risk factors for selection of hysterectomy(P<0.05).Multiple uterine myoma,uterine myoma with diameter≥5 cm,uterine myoma in cervix or broad ligament,and adenomyosis or endometriosis were the independent risk factors for selection of laparotomy(P<o.05).Conclusion Older age,multiple uterine myoma,oversized uterine myoma and complications are the influencing factors for hysterectomy.Multiple uterine myoma,oversized uterine myoma,uterine myoma in a special location and adenomyosis or endometriosis are the influencing factors for selection of laparotomy.