Department of Gynecology and Obstetrics, Universidade Federal Fluminense, Rio de Janeiro, Brazil.
J Minim Invasive Gynecol. 2012 Sep-Oct;19(5):575-80. doi: 10.1016/j.jmig.2012.03.026. Epub 2012 Jul 20.
To evaluate 2 different predicting scores of submucous myoma removal, fluid balance, and operative time in woman undergoing hysteroscopic myomectomy.
A multicenter and prospective study (Canadian Task Force classification II-2).
Six hysteroscopy centers in Brazil.
A total of 191 women who underwent hysteroscopic resection of 205 submucous myomas.
Resection of submucous myomas (hysteroscopic myomectomy). Myomas were scored according to the European Society for Gynaecological Endoscopy (ESGE) and STEPW (size, topography, extension, penetration, and wall) classifications. The validation of the 2 classifications was assessed with sensitivity and specificity of each classification, with their best cutoff point.
To correlate ESGE and STEPW classifications with complete or incomplete removal of submucous myoma, length of surgery, surgical complications, and fluid balance.
Removal of the myoma was complete in 190 (92.7%) of 205 myomectomies, and incomplete in 15 (7.3%). All 140 (100%) of 140 myomas with a score ≤ 4 in the STEPW classification were completely removed, and 50 (76.9%) of 65 myomas with a score >4 were removed. All 15 (100%) cases of incomplete hysteroscopic myomectomy had a STEPW score >4. With the ESGE classification, 156/164 (95.1%) cases of type 0 and type 1 myomas, and 34/41 (82.9%) of type 2 were completely resected. STEPW scores >4 were statistically associated with longer duration of surgery, surgical complications, higher levels of fluid balance, and use of gonadotropin releasing hormone analogue if compared with lower scores. The ESGE scores were not associated with any of these variables.
Classifying submucous myomas with the STEPW classification allows better prediction of myoma removal, fluid balance, length of surgery and surgical complications in hysteroscopic myomectomy than ESGE classification.
评估 2 种不同的黏膜下肌瘤切除预测评分、液体平衡和手术时间，用于接受宫腔镜子宫肌瘤切除术的女性。
多中心前瞻性研究（加拿大任务组分类 II-2）。
巴西的 6 个宫腔镜中心。
共 191 名接受宫腔镜下黏膜下肌瘤切除术的女性。
切除黏膜下肌瘤（宫腔镜子宫肌瘤切除术）。根据欧洲妇科内镜学会（ESGE）和 STEPW（大小、地形、延伸、穿透和壁）分类对肌瘤进行评分。评估 2 种分类的验证采用每种分类的敏感性和特异性，以及其最佳截断点。
将 ESGE 和 STEPW 分类与黏膜下肌瘤的完全或不完全切除、手术时间、手术并发症和液体平衡相关联。
205 例子宫肌瘤切除术中有 190 例（92.7%）肌瘤完全切除，15 例（7.3%）肌瘤不完全切除。STE PW 分类评分≤4 的 140 例（100%）肌瘤均完全切除，评分>4 的 65 例（76.9%）肌瘤中有 50 例切除。STE PW 评分>4 的 15 例（100%）不完全宫腔镜子宫肌瘤切除术病例。使用 ESGE 分类，0 型和 1 型肌瘤中的 156/164 例（95.1%）和 2 型肌瘤中的 34/41 例（82.9%）完全切除。与较低评分相比，STE PW 评分>4 与手术时间延长、手术并发症、液体平衡水平升高以及使用促性腺激素释放激素类似物相关。ESGE 评分与这些变量均无关联。
与 ESGE 分类相比，使用 STEPW 分类对黏膜下肌瘤进行分类可更好地预测宫腔镜子宫肌瘤切除术中的肌瘤切除、液体平衡、手术时间和手术并发症。
