Kim Da Hee, Kim Mi-La, Song Taejong, Kim Mi Kyoung, Yoon Bo Sung, Seong Seok Ju
Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, 566, Nonhyeon-ro, Gangnam-gu, Seoul 135-081, Republic of Korea.
Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, 566, Nonhyeon-ro, Gangnam-gu, Seoul 135-081, Republic of Korea.
Eur J Obstet Gynecol Reprod Biol. 2014 Jun;177:57-60. doi: 10.1016/j.ejogrb.2014.04.006. Epub 2014 Apr 18.
The aim of this study was to evaluate the recurrence and reoperation rate after myomectomy in women aged 45 years and older, who want to preserve their uterus.
We performed a retrospective review of women aged ≥45 years that underwent myomectomy between January 2000 and December 2010. The inclusion criteria were premenopausal status, myomectomy through abdominal or laparoscopic surgery, and at least 12 months interval from surgery. The clinical outcomes, including symptomatic change, recurrence of myoma on transvaginal ultrasonography (TVS), and reoperation data were collected and analyzed.
A total 92 patients were included in this study. The median age of the patient was 47 years (range 45-53 years), and the median follow-up duration was 30.5 months (range 12-95 months). On follow-up TVS, the recurrence of myoma was detected in 20 of 82 (24.4%) patients. Ten (10.9%) patients were not subjected to follow-up TVS. However, during their pelvic examination, the uterus was normal size, and all the 10 patients experienced symptomatic improvement and none of them needed additional surgical management. Using the Kaplan-Meier method, the cumulative recurrence rate at 36 months after myomectomy was calculated as 17.1%. Three patients underwent hysterectomy during the follow-up periods, and only one underwent hysterectomy due to myoma. The overall reoperation rate after myomectomy in this age group was 3.3%, and the reoperation for myoma rate was only 1.1%.
Considering the natural regression of myoma after menopause, myomectomy might be an effective option for women aged 45 years and older, who want to preserve their uterus.
本研究旨在评估45岁及以上希望保留子宫的女性子宫肌瘤切除术后的复发率和再次手术率。
我们对2000年1月至2010年12月期间接受子宫肌瘤切除术的45岁及以上女性进行了回顾性研究。纳入标准为绝经前状态、经腹或腹腔镜手术进行子宫肌瘤切除术以及术后至少间隔12个月。收集并分析临床结局，包括症状变化、经阴道超声检查（TVS）发现的肌瘤复发情况以及再次手术数据。
本研究共纳入92例患者。患者的中位年龄为47岁（范围45 - 53岁），中位随访时间为30.5个月（范围12 - 95个月）。在随访TVS检查中，82例患者中有20例（24.4%）检测到肌瘤复发。10例（10.9%）患者未接受随访TVS检查。然而，在她们的盆腔检查中，子宫大小正常，所有10例患者症状均有改善，且均无需额外的手术治疗。采用Kaplan-Meier方法计算，子宫肌瘤切除术后36个月的累积复发率为17.1%。随访期间有3例患者接受了子宫切除术，其中仅1例因肌瘤接受子宫切除术。该年龄组子宫肌瘤切除术后的总体再次手术率为3.3%，因肌瘤再次手术率仅为1.1%。
考虑到绝经后肌瘤的自然消退，子宫肌瘤切除术可能是45岁及以上希望保留子宫的女性的有效选择。
