宫腔镜治疗粘膜下子宫肌瘤的临床应用

Hysteroscopic Surgery for Submucous Myoma

目的 应用宫腔镜手术治疗粘膜下子宫肌瘤 ,并评价这种方法的疗效和安全性。方法 因子宫异常出血、不孕症、流产等经B超或者宫腔镜检查诊断为粘膜下肌瘤 ,而行宫腔镜下子宫肌瘤电切术或同时行子宫内膜电切术 96例 ,其中 0型粘膜下子宫肌瘤 6 2例 ,Ⅰ型 2 8例 ,Ⅱ型 6例 ,术后随访 3～ 2 4个月。根据术后月经改善情况、是否有剩余肌瘤、剩余肌瘤有无增长、是否再次手术等将疗效分为满意和不满意。并根据并发症情况评价其安全性。结果 应用宫腔镜手术治疗粘膜下肌瘤术后满意度为 98 96 % ,其中 0型、Ⅰ型术后满意度 1 0 0 % ,4 2例要求妊娠者已妊娠 2 9例 ,2 1例已分娩。Ⅱ型子宫肌瘤术后满意度 83 33%。除 1例发生宫腔粘连 ,1例术后发热 ,1例术后出血外 ,无其他并发症发生。结论 宫腔镜手术治疗粘膜下子宫肌瘤有效、安全 。

Objective To treat submucous myoma by hysteroscopic surgery,and to eva1uate its curative effect and safety. Methods 96 patients with submucous myoma which were diagnosed by hysteroscopy or ultrasound examination, dued to abnormal uterine bleeding, infertility or abortion, were performed hysteroscopic myomectomy and/or hysteroscopic resection of endometrium.Among them, there were 62 cases of type 0, 28 cases of type I and 6 cases of type Ⅱ. The period of follow up was 3～24 months. On the basis of controlling bleeding, surplus of myoma, growth of myoma and subsequent surgery,the treatment results were divided into two groups: satisfaction and dissatisfaction. And the safety was evaluated on the basis of the complications.Results After resection, 98 6% of all patients the treatment was satisfaction. The treatment in 0 and Ⅰ type were 100% satisfaction. In 42 patients who wanted to reserve fertility, 29 of them were pregnant, in which 21 were full term birth. treatment in type Ⅱ was 83 33% satisfaction. No other complication occurred expect one case had intrauterine adhesion and one case abnormal uterine bleeding.Conclusion Hysteroscopic myomectomy is a highly effective and safe method in the treatment of submucous myoma , and is the best choice of treatment at present.