宫腔镜电切术治疗子宫肌瘤962例疗效分析

目的探讨宫腔镜电切子宫肌瘤(TCRM)的手术方法及预后。方法对962例子宫肌瘤患者进行了TCRM手术,术中进行B超声或腹腔镜监护。962例中0型子宫肌瘤281例,Ⅰ型316例,Ⅱ型282例,多发黏膜下及壁间肌瘤34例,宫颈肌瘤11例,脱出肌瘤23例,子宫腺肌瘤15例。用TCRM五步手法实施手术。结果962例患者的子宫大小平均为孕(74±13)周(5~11周),宫腔深度平均(83±14)cm(7~13cm),切除肌瘤最大直径为72cm。一次手术成功率为9977%。切除肌瘤重量平均(23±31)g(4~145g)。手术时间平均(32±173)min(9~145min)。术中出血平均(8±19)ml(5~400ml),无输血者。并发症为一过性发热3例,子宫出血1例,子宫穿孔1例,TURP综合征2例。术后月经减少情况0型黏膜下肌瘤为100%,Ⅰ型为991%,Ⅱ型为9402%,宫颈肌瘤和脱出肌瘤为100%,多发黏膜下及壁间肌瘤为84%,子宫腺肌瘤为87%。术后痛经减轻的比例为78%,贫血治愈比例8295%。结论TCRM切除子宫肌瘤安全、高效,是子宫黏膜下和壁间肌瘤的首选治疗方法。

Transcervical resection of myoma in treatment of hysteromyoma, experience in 962 x\cases

OBJECTIVE: To study the technique and effect of transcervical resection of myoma (TCRM) in treatment of hysteromyoma. METHODS: 962 women suffering type 0 hysteromyoma (n = 281), 316 type 1 hysteromyoma (n = 316), type 2 hysteromyoma (n = 282), submucous and intramural myoma (n = 34), cervical myoma (n = 11), prolapse myoma (n = 23), and adenomyoma (n = 15) underwent TCRM with "five-step technique", monitored by B-ultrasound or laparoscopy, Follow-up lasted more than 6 months. RESULTS: The primary operation successful rate was 99.77%. The mean size and depth of uterus were 7.44 +/- 1.3 gestation weeks and (8.31 +/- 1.43) cm, the diameter of the biggest myoma was 7.2 cm. The mean weight of the resected tissues was (22.63 +/- 31.41) g, and the mean operation time and blood loss during the operation were 32.50 +/- 172.72 minutes and (7.75 +/- 19.49) ml. No transfusion was needed. The complications included postoperative fever (3 cases), uterine bleeding (1 case), uterine perforation (1 case), and TURP syndrome (2 cases). Postoperative scanty menstrual rate was 100% in the type 0 hysteromyoma group, 99.1% in the type I hysteromyoma group, 94.02% in the type II hysteromyoma group, 100% in the cervical myoma and prolapse myoma group, 84% in the multiple myoma and intramural myoma group, and 87% in the adenomyoma group respectively. The alleviation rates of dysmenorrhea and anemia were 78% and 82.95% respectively. Those who have severe complications of internal medicine showed obvious improvement. The residual myoma of 2 cases were resected during the secondary operation 9 days and 3 months after the primary operation. 455 cases (52.17%) resumed their work in 1 month postoperatively. 32 living infants were delivered. CONCLUSION: Safe and highly effective, TCRM can be the first choice in treatment of submucous and intramural hysteromyoma.