Jacobson Gavin F, Shaber Ruth E, Armstrong Mary Anne, Hung Yun-Yi
Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, San Francisco, CA, USA.
Am J Obstet Gynecol. 2007 Jun;196(6):601.e1-5; discussion 601.e5-6. doi: 10.1016/j.ajog.2007.03.009.
The purpose of this study was to investigate treatment of uterine leiomyoma by hysterectomy and uterine conserving procedures (UCPs).
Data from Kaiser Permanente Northern California members undergoing hysterectomy, myomectomy, uterine artery embolization (UAE) and endometrial ablation (EA) for uterine leiomyoma from 1997-2003 were collected. Statistical analysis included trend tests and survival analysis.
Hysterectomy rates for leiomyoma decreased significantly from 2.13 per 1000 to 1.91 (P < .0001). Rates for myomectomy (.4-.37) and EA (.26-.27) remained stable (P = .17 and .26, respectively), whereas rates for UAE increased significantly from < .01-.24 (P < .0001). The combined rates for hysterectomy and UCPs remained stable at 2.79 (P = .95). Rate of hysterectomy after UCP increased over time, and at 6 years reached 11.5%, 17.7%, and 7.9% for EA, UAE, and myomectomy, respectively.
Whereas rate of hysterectomy for leiomyoma decreased, total rate of invasive treatment remained stable. Increase in rate of UAE had the greatest impact on treatment, possibly replacing hysterectomy.
本研究旨在探讨子宫切除术及子宫保留手术（UCPs）治疗子宫平滑肌瘤的情况。
收集了1997年至2003年期间北加利福尼亚凯撒医疗集团因子宫平滑肌瘤接受子宫切除术、肌瘤切除术、子宫动脉栓塞术（UAE）和子宫内膜切除术（EA）的会员数据。统计分析包括趋势检验和生存分析。
子宫平滑肌瘤的子宫切除率从每1000人2.13例显著降至1.91例（P <.0001）。肌瘤切除术（从0.4降至0.37）和EA（从0.26降至0.27）的比率保持稳定（P分别为0.17和0.26），而UAE的比率从<0.01显著增至0.24（P <.0001）。子宫切除术和UCPs的综合比率稳定在2.79（P = 0.95）。UCP后子宫切除率随时间增加，6年后，EA、UAE和肌瘤切除术的子宫切除率分别达到11.5%、17.7%和7.9%。
虽然子宫平滑肌瘤的子宫切除率下降，但侵入性治疗的总比率保持稳定。UAE比率的增加对治疗影响最大，可能会取代子宫切除术。
