GINTEAM Unit of Minimally Invasive Gynaecology, Department of Public Health and Microbiology, University of Turin, Turin, Italy.
J Minim Invasive Gynecol. 2010 Jan-Feb;17(1):59-65. doi: 10.1016/j.jmig.2009.10.013.
To evaluate the feasibility of hysteroscopic resection of large submucous uterine myomas.
Prospective study (Canadian Task Force classification II-3).
Surgery unit of minimally invasive gynecology.
Thirty-three women with submucous myomas 5 cm or larger in diameter with menorrhagia, dysmenorrhea, or infertility.
Hysteroscopic myomectomy.
Satisfaction with the surgery and an improvement in symptoms were the primary outcomes. Possibility of 1-step resection; complication rate, and disease recurrence were also considered. Menorrhagia was the most frequent indication (91%). According to the Wamsteker classification, 84.8% were type II myomas, whereas 93.9% scored 5 or higher according to the classification of Lasmar and colleagues. Mean operating time was 50 minutes (interquartile range, 35-65). One-step excision was achieved in 81.8% of patients. Of 5 women with incomplete resection, 3 needed a second surgery, and 2 were symptom-free. Patients with myomas larger than 5 cm or with a Lasmar score higher than 7 were more likely to undergo a 2-step procedure. In patients with myomas larger than 6 cm, recovery time was significantly longer than in those with smaller myomas. We recorded 3 complications: intravasation, uterine perforation, and postoperative anemia, in 1 patient each; at present, all 3 women are symptom-free. Median (range) follow-up was 10 (6-22) months. Twenty-seven patients (81.2%) reported they were very satisfied; 5 patients (15.2%) were satisfied; and 1 patient (3%) was dissatisfied.
Hysteroscopic myomectomy can be the treatment of choice in symptomatic patients with a submucous myoma with diameter of 6 cm or less. Although this technique raises the possibility that complete resection may require 2 surgical sessions, it is a feasible surgical procedure. However, for myomas 6 cm or larger in diameter, this approach is less attractive. Nevertheless, we believe that all of the limiting criteria defined in the available literature should be evaluated individually, bearing in mind each patient's particular condition and the surgeon's experience and skill.
评估宫腔镜下切除大的黏膜下子宫肌瘤的可行性。
前瞻性研究（加拿大工作队分类 II-3）。
微创妇科手术单元。
33 名直径 5 厘米或更大的黏膜下子宫肌瘤、月经过多、痛经或不孕的妇女。
宫腔镜下子宫肌瘤切除术。
手术满意度和症状改善是主要结果。考虑了 1 步切除的可能性、并发症发生率和疾病复发率。月经过多是最常见的指征（91%）。根据 Wamsteker 分类，84.8%为 II 型肌瘤，而根据 Lasmar 等人的分类，93.9%的评分在 5 分或以上。平均手术时间为 50 分钟（四分位间距，35-65）。81.8%的患者实现了 1 步切除。5 名不完全切除的患者中，有 3 名需要再次手术，2 名患者症状消失。肌瘤大于 5 厘米或 Lasmar 评分大于 7 的患者更有可能需要进行 2 步手术。肌瘤大于 6 厘米的患者康复时间明显长于肌瘤较小的患者。我们记录了 3 例并发症：1 例患者出现血管内输注、子宫穿孔和术后贫血，目前所有 3 例患者均无症状。中位数（范围）随访时间为 10（6-22）个月。27 名患者（81.2%）报告非常满意；5 名患者（15.2%）满意；1 名患者（3%）不满意。
宫腔镜下子宫肌瘤切除术可作为直径 6 厘米或以下有症状的黏膜下子宫肌瘤患者的首选治疗方法。虽然该技术可能需要 2 次手术才能完全切除，但这是一种可行的手术方法。然而，对于直径 6 厘米或更大的肌瘤，这种方法的吸引力较小。然而，我们认为，应根据患者的具体情况和外科医生的经验和技能，单独评估现有文献中定义的所有限制标准。
