米非司酮配伍米索前列醇术前宫颈预处理在子宫黏膜下大肌瘤宫腔镜电切术中的应用

目的:探讨子宫黏膜下大肌瘤宫腔镜电切术(transcervical resection of myoma,TCRM)术前使宫颈扩张的有效方法。方法:广西南宁市妇幼保健院2008年1月—2012年9月对53例直径≥5 cm的子宫黏膜下大肌瘤患者行TCRM,53例中0型27例,Ⅰ型19例,Ⅱ型7例。患者术前口服米非司酮50 mg/d,连服3 d;术前4 h予米索前列醇600μg阴道放置,宫颈预处理后行TCRM。分析各型肌瘤患者的宫颈扩张情况、手术时间、术中出血量、肌瘤质量、并发症、术后月经及妊娠情况等。结果:所有患者宫颈扩张满意,均顺利完成手术。3组患者平均手术时间均少于50 min,Ⅰ型组、0型组患者手术时间明显短于Ⅱ型组,差异有统计学意义(P0.01)。3组患者平均术中出血量均小于50 mL,Ⅰ型组、0型组术中出血量明显少于Ⅱ型组,差异有统计学意义(P0.01)。3组患者肌瘤平均质量均大于80 g,差异无统计学意义(P0.05)。术后2个月发生宫颈内口粘连1例,术后23个月(产后7个月)正常月经复潮1例,其余患者术后第1次月经量即恢复正常,2个月血红蛋白全部恢复正常。53例患者均无大出血、稀释性低钠血症、感染等并发症;其中13例有生育要求者11例成功妊娠。结论:米非司酮配伍米索前列醇术前宫颈预处理可有效扩张宫颈,有利于子宫黏膜下大肌瘤行TCRM,可缩短手术时间,减少手术并发症。

Preoperative Cervical Pretreatment with Mifepristone and Misoprostol in Transcervicai Resection of Large Submucosal Myoma of Uterus

Objective：To investigate the effective way to expand cervix by means of transeervical resection of myoma（TCRM） on large submucosal myoma of uterus. Methods：TCRM was performed in 53 patients in whom the diameters of the submucosal myoma of uterus were more than 5 cm from Jan 2008 to Sep 2012 in Guangxi Nanning Maternity and Child Care Center. Among the 53 patients,27 were 0 type,19 were I type and 7 were II type. The patients orally took mifepristone for 3 days（50 mg per day） before TCRM,and 600 μg of misoprostol was placed into the vagina 4 hours before the operation. TCRM was performed after cervical pretreatment. The cervical expansion, operation time, amount of bleeding, myoma weight, complications, menstrua- tion and pregnancy after the operation were analyzed. Results： The cervical expansion was satisfactory and the operation was successful in all patients. The average operation time in 3 groups was less than 50 minutes. The operation time in I type and 0 type was obviously shorter than that in II type（P〈0. 01）. The average amount of bleeding in 3 groups was lower than 50 mL. The amoums of bleeding in I type and 0 type were also obviously lower than that in II type（P〈0.01）. The average weight of myoma in the 3 groups was more than 80 g, and the differences in the 3 groups had no statistical significance（P〉0.05）. Adhesion in internal orifice of cervix was found in one patient two months after the operation. One patientrs menstruation become normal twenty-three months after the operation（seven months after delivery） , and other patientsr blood volumes turned normal in their first menstrual period after the operation and hemoglobin turned normal at two months after the operation. No massive haemorrhage,dilutional hyponatremia,infection and other complications were found. A total of 11 patients got successful pre- gnancy among the 13 patients desiring for fertility. Conclusions： The preoperative cervical pretreatment with mifepristone and misoprostol is an effective way to expand cervix and is good for TCRM on large submucosal myoma of uterus. It can shorten the operation time and reduce the occurrence of complications.