Assisted Conception Unit, Guy's and St. Thomas' NHS Trust, London, UK.
Eur J Obstet Gynecol Reprod Biol. 2013 Apr;167(2):219-24. doi: 10.1016/j.ejogrb.2012.12.010. Epub 2013 Jan 3.
To evaluate the safety of abdominal myomectomy for very large fibroid uteri, and to assess the effect of relevant confounding variables on the occurrence of major peri-operative complications.
A cohort study of 200 abdominal myomectomies for fibroid uteri of 16 gestational weeks or greater. Logistic regression analysis was used to examine the influence of important clinical variables on the risk of complications. A systematic literature search was conducted for evidence related to peri-operative morbidity associated with abdominal myomectomy for very large fibroid uteri.
The mean (±standard deviation) uterine size was 21±5 weeks. The overall rate of major complications was 30%. Peri-operative bleeding necessitating blood transfusion occurred in 49 (24.5%) cases. During surgery, two patients had bowel injury, two had bladder injury, seven women returned to theatre and two (1%) had hysterectomy. Four patients were re-admitted within 14 days of surgery. Multivariable logistic regression analysis showed that the risk of major complications was significantly higher in cases with a uterine size of 20 gestational weeks or more [odds ratio (OR) 3.4, 95% confidence interval (CI) 1.1-10.2; p=0.03], where 10 or more fibroids were removed (OR 3.5, 95% CI 1.1-10.8; p=0.05) and where midline skin incision was required (OR 6.1, 95% CI 1.7-22.3; p=0.006). On comparison of primary vs repeat abdominal myomectomy, there was significantly higher blood loss (mean 1023±1112 ml vs 579±787 ml; p=0.02) and risk of major complications in the repeat myomectomy group (40% vs 5%; p<0.001). The systematic review identified only one study that reported a comparable risk of major complications related to abdominal myomectomy for very large fibroid uteri.
The risk of organ injury, hysterectomy, re-operation or hospital re-admission after abdominal myomectomy for very large fibroid uteri is low, but the procedure is associated with a significant risk of bleeding necessitating blood transfusion. This risk is increased after repeat myomectomy, and in patients with a uterine size of 20 gestational weeks or larger, requiring removal of 10 or more fibroids, and requiring a midline skin incision.
评估经腹子宫肌瘤剔除术治疗巨大子宫肌瘤的安全性，并评估相关混杂变量对主要围手术期并发症发生的影响。
对 200 例妊娠 16 周或以上的子宫肌瘤行经腹子宫肌瘤剔除术的队列研究。采用逻辑回归分析方法，研究重要临床变量对并发症风险的影响。对与经腹剔除巨大子宫肌瘤相关的围手术期发病率相关的证据进行系统文献检索。
子宫大小的平均值（±标准差）为 21±5 孕周。总的主要并发症发生率为 30%。术中需要输血的围手术期出血发生在 49 例（24.5%）中。术中 2 例发生肠损伤，2 例发生膀胱损伤，7 例患者返回手术室，2 例（1%）行子宫切除术。4 例患者在手术后 14 天内再次入院。多变量逻辑回归分析显示，子宫大小为 20 孕周或以上时，主要并发症的风险显著升高[比值比（OR）3.4，95%置信区间（CI）1.1-10.2；p=0.03]，切除 10 个或更多肌瘤时（OR 3.5，95%CI 1.1-10.8；p=0.05），以及需要正中皮肤切口时（OR 6.1，95%CI 1.7-22.3；p=0.006）。在原发性与复发性经腹子宫肌瘤剔除术比较中，复发性子宫肌瘤剔除术组的出血量（平均 1023±1112ml 比 579±787ml；p=0.02）和主要并发症风险显著升高（40%比 5%；p<0.001）。系统评价仅发现 1 项研究报告了经腹剔除巨大子宫肌瘤相关的主要并发症风险相似。
经腹剔除巨大子宫肌瘤后发生器官损伤、子宫切除、再次手术或住院的风险较低，但该手术有明显的输血相关出血风险。这种风险在复发性子宫肌瘤剔除术、子宫大小为 20 孕周或更大、需要切除 10 个或更多肌瘤以及需要正中皮肤切口时增加。
