[经宫颈肌瘤切除术治疗子宫肌瘤：962例经验]

Xia En-lan, Duan Hua, Huang Xiao-wu, Zheng Jie, Yu Dan

Hysteroscopy Center, Fuxing Hospital, Beijing 100038, China.

Zhonghua Yi Xue Za Zhi. 2005 Jan 19;85(3):173-6.

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.

目的

探讨经宫颈肌瘤切除术（TCRM）治疗子宫肌瘤的技术及效果。

方法

962例患有0型子宫肌瘤（n = 281）、1型子宫肌瘤（n = 316）、2型子宫肌瘤（n = 282）、黏膜下及肌壁间肌瘤（n = 34）、宫颈肌瘤（n = 11）、脱垂肌瘤（n = 23）及子宫腺肌病（n = 15）的患者采用“五步技术”行TCRM，术中采用B超或腹腔镜监测，随访时间超过6个月。

结果

一期手术成功率为99.77%。子宫平均大小及深度分别为7.44±1.3孕周和（8.31±1.43）cm，最大肌瘤直径为7.2cm。切除组织平均重量为（22.63±31.41）g，平均手术时间及术中出血量分别为32.50±172.72分钟和（7.75±19.49）ml，均无需输血。并发症包括术后发热（3例）、子宫出血（1例）、子宫穿孔（1例）及TURP综合征（2例）。0型子宫肌瘤组术后月经量减少率为100%，Ⅰ型子宫肌瘤组为99.1%，Ⅱ型子宫肌瘤组为94.02%，宫颈肌瘤及脱垂肌瘤组为100%，多发肌瘤及肌壁间肌瘤组为84%，子宫腺肌病组为87%。痛经及贫血缓解率分别为78%和82.95%。内科严重并发症患者症状明显改善。2例残留肌瘤分别于一期手术后9天及3个月行二期手术切除。455例（52.17%）患者术后1个月恢复工作。32例患者分娩活婴。