子宫平滑肌瘤腹腔镜术后复发影响因素分析

Analysis of the influencing factors of the uterine leiomyoma recurrence after laparoscopic surgery

目的:分析子宫平滑肌瘤腹腔镜术后复发影响因素。方法:收集2016年1月-2021年12月在本院行腹腔镜下子宫平滑肌瘤剔除术患者586例临床及随访资料。统计患者的术后复发情况,依据是否复发分为复发组(n=82)与未复发组(n=504)。比较两组临床资料,分析导致术后复发的独立危险因素。结果:术后病情随访12.17±4.53个月,肌瘤术后复发率为14.0%,术后复发时间8.71±2.81个月。单因素分析,患者家族史、术前妊娠史、术后妊娠、肌瘤主要位置、子宫大小、手术时体质指数(BMI)与术后复发无明显关系(P>0.05),初潮年龄、术后药物治疗、肌瘤数量、年龄(手术时)、最大肌瘤直径,以及血清性激素雌二醇(E_(2))、孕酮(P)、泌乳素(PRL)卵泡刺激素(FSH)、黄体生成素(LH)水平与术后复发存在明显关系(P<0.05)。logistic回归分析显示,手术时年龄≥40岁、肌瘤数量≥2个、最大肌瘤直径≥10cm及E_(2)、P、PRL、FSH、LH水平升高是子宫平滑肌瘤腹腔镜术后复发的独立危险因素(均P<0.05)。结论:本次分析的子宫平滑肌瘤腹腔镜术后复发率较高,临床应提高对手术时年龄≥40岁、肌瘤数量多发、体积较大肌瘤、性激素水平高等肌瘤复发高危患者的重视,加强术后随访。

Objective:To analyze the influencing factors of the uterine leiomyoma recurrence of patients after laparoscopic surgery.Methods:The clinical data and the follow-up data of 586 patients who had undergone the laparoscopic surgery of the uterine leiomyoma in the hospital between January 2016 and December 2021 were collected.The situations of the uterine leiomyoma recurrence of the patients were counted.According to the presence or absence of the postoperative uterine leiomyoma recurrence,these patients were divided into group A (82cases with the uterine leiomyoma recurrence)and group B(504cases without the uterine leiomyoma recurrence).The clinical data of the patients were compared between the two groups.The independent risk factors of the postoperative uterine leiomyoma recurrence of the patients were analyzed.Results:The average postoperative follow-up period of the patients was 12.17±4.53 months.The postoperative uterine leiomyoma recurrence rate of the patients was 14.0%,and the postoperative recurrence time of the uterine leiomyoma was 8.71±2.81 months.Univariate analysis showed that the family history of the uterine leiomyoma,the preoperative pregnancy history,the postoperative pregnancy,the main location and size of the uterine leiomyoma,and the body mass index(BMI)at the time of surgery of the patients were not significantly correlation with their postoperative recurrence of the uterine leiomyoma(P>0.05).The age at menarche,the postoperative drug therapy,the uterine leiomyoma number,the age(at the time of surgery),the maximum diameter of the uterine leiomyoma,and the levels of serum estradiol(E_(2)),progesterone(P),prolactin(PRL),follicle-stimulating hormone(FSH)and luteinizing hormone(LH)of the patients were significantly correlation with their postoperative recurrence of the uterine leiomyoma(P<0.05).Logistic regression analysis showed that the age≥40 years old,the number of leiomyoma≥2,the maximum leiomyoma diameter≥10cm,and the increased levels of E_(2),P,PRL,FSH and LH of the patients were the independent risk factors of their uterine leiomyoma recurrence after laparoscopic surgery(all P<0.05).Conclusion:The recurrence rate of the uterine leiomyomais of the patients after the laparoscopic myomectomy is higher.Clinically,the close attention should be paid to the patients with high-risk of the postoperative uterine leiomyoma recurrence,such as the age≥40 years old,the multiple and large fibroids,and the high levels of sex hormones.The postoperative follow-up of the patients should be enhanced.