评估在中国行阴道子宫肌瘤剔除术的可行性和安全性。

Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China.

Chin Med J (Engl). 2011 Nov;124(21):3481-4.

BACKGROUND

Classically, myomectomy has been performed via laparotomy, but laparoscopic myomectomy has now become a valuable treatment option. Vaginal myomectomy as a minimal invasive procedure has also been evaluated; however, its feasibility and safety are controversial with few clinical trials published. This study was designed to evaluate the feasibility of vaginal myomectomy in China and to document any associated complications.

METHODS

From January 2005 to December 2010, 43 patients with symptomatic myomas were admitted for vaginal myomectomy in Peking Union Medical College Hospital (PUMCH). The indications, operative performance, postoperative complications and outcome of these patients were analyzed retrospectively.

RESULTS

Myomectomy was performed vaginally in all patients. The mean operating time was (66.4 ± 22.6) minutes and the mean operative blood loss and hospital stay were (78.3 ± 64.4) ml and (4.9 ± 3.3) days, respectively. Five (12%) patients developed febrile morbidity and experienced a high postoperative temperature (mean 38.4°C). Postoperative fever was associated with greater operative trauma, longer operative time and greater weight of the tumor (all P < 0.01). The cost of surgery was RMB (820.6 ± 339.1) Yuan ((124.3 ± 51.4) US dollars) and the total medical cost was RMB (4880.4 ± 1088.4) Yuan ((739.5 ± 164.9) US dollars). Three patients later conceived spontaneously and had uneventful vaginal deliveries. Only one patient had a tumor recurrence during the following-up period.

CONCLUSION

Vaginal myomectomy is a feasible and safe surgical procedure with low recurrence and complication rates.

背景

传统上，子宫肌瘤切除术通过剖腹手术进行，但腹腔镜子宫肌瘤切除术现在已成为一种有价值的治疗选择。阴道子宫肌瘤切除术作为一种微创术式也已得到评估；然而，其可行性和安全性存在争议，仅有少数临床试验发表。本研究旨在评估阴道子宫肌瘤切除术在中国的可行性，并记录任何相关的并发症。

方法

2005 年 1 月至 2010 年 12 月，43 例有症状的子宫肌瘤患者在北京协和医院（PUMCH）接受阴道子宫肌瘤切除术。回顾性分析这些患者的适应证、手术操作、术后并发症和结果。

结果

所有患者均经阴道行子宫肌瘤切除术。平均手术时间为（66.4 ± 22.6）分钟，平均手术出血量和住院时间分别为（78.3 ± 64.4）ml 和（4.9 ± 3.3）天。5 例（12%）患者发生发热性发病率，术后体温升高（平均 38.4°C）。术后发热与手术创伤更大、手术时间更长和肿瘤重量更大有关（均 P < 0.01）。手术费用为人民币（820.6 ± 339.1）元（（124.3 ± 51.4）美元），总医疗费用为人民币（4880.4 ± 1088.4）元（（739.5 ± 164.9）美元）。3 例患者随后自然受孕并顺利经阴道分娩。只有 1 例患者在随访期间肿瘤复发。