Maternal and Fetal Health Research Unit, Department of Obstetrics and Gynecology, Olabisi Onabanjo University Teaching Hospital, P.M.B. 2001, Sagamu, Ogun State, Nigeria.
Arch Gynecol Obstet. 2011 Apr;283(4):825-30. doi: 10.1007/s00404-010-1460-y. Epub 2010 Apr 9.
Data on comparative outcomes of abdominal myomectomy for varying uterine sizes that could guide informed decision by women and clinicians in resource-constrained settings are scarce.
To evaluate safety of abdominal myomectomy and compare perioperative morbidities for women with very large uterine size (≥20 weeks) with that of women with smaller uterine size (<20 weeks) in a developing country hospital.
Retrospective and comparative chart review of 224 women with uterine sizes between 12 and 36 weeks who had abdominal myomectomy performed at a Nigerian university hospital. Primary outcome measure was overall perioperative morbidity, with the following secondary outcomes: hemorrhage, febrile morbidity, unintended major surgical procedures, life-threatening events, and rehospitalization (according to validated criteria). Other variables included operating time, estimated blood loss, wound complications and postoperative hospital stay.
Overall morbidity occurred in 31.7% of women with hemorrhage (20.5%) and febrile morbidity (16.1%) being leading contributors. Unintended procedures (0.9%) and life-threatening events (1.8%) were rare and no death was recorded. Forty women (17.9%) had blood loss ≥ 1 l and 11.6% received homologous blood transfusion. Overall morbidity and all secondary morbidity outcomes (according to predefined criteria) were comparable between women with very large uterine size and those with smaller uteri. However, the mean blood loss was significantly more and the procedure and average hospital stay were significantly longer in women with very large uterine size.
Abdominal myomectomy in this setting is associated with significant but acceptable perioperative morbidity. Increased uterine size does not significantly affect clinically important morbidities and women with very large uterine size should not be denied this procedure for safety concerns.
关于不同子宫大小的腹式子宫肌瘤切除术的比较结果的数据，这些数据可以为资源有限环境下的女性和临床医生提供决策依据，但此类数据非常缺乏。
评估腹式子宫肌瘤切除术的安全性，并比较在发展中国家医院中，子宫大小非常大（≥20 孕周）的女性与子宫较小（＜20 孕周）的女性的围手术期并发症。
回顾性比较了在尼日利亚一所大学医院接受腹式子宫肌瘤切除术的 224 名子宫大小在 12 至 36 孕周之间的女性患者的图表。主要结局指标是整体围手术期发病率，次要结局指标包括出血、发热发病率、意外的主要手术、危及生命的事件和再入院（根据验证标准）。其他变量包括手术时间、估计失血量、伤口并发症和术后住院时间。
31.7%的女性发生了总体发病率，其中出血（20.5%）和发热发病率（16.1%）是主要原因。意外手术（0.9%）和危及生命的事件（1.8%）很少见，没有死亡记录。40 名女性（17.9%）的失血量≥1 l，11.6%接受了同种异体输血。子宫大小非常大的女性与子宫较小的女性相比，总体发病率和所有次要发病率结果（根据预先定义的标准）相当。然而，子宫大小非常大的女性的平均失血量明显更多，手术和平均住院时间明显更长。
在这种情况下，腹式子宫肌瘤切除术与明显但可接受的围手术期发病率相关。子宫大小的增加不会显著影响重要的临床发病率，因此，不应因安全性问题而拒绝为子宫大小非常大的女性提供这种手术。
