Tan-Kim Jasmine, Hartzell Katherine A, Reinsch Caryl S, O'Day Cristina H, Kennedy John S, Menefee Shawn A, Harrison Terry A
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Kaiser Permanente San Diego, San Diego, CA.
Department of Obstetrics and Gynecology, Kaiser Permanente San Diego, San Diego, CA.
Am J Obstet Gynecol. 2015 May;212(5):594.e1-10. doi: 10.1016/j.ajog.2014.12.002. Epub 2014 Dec 11.
The purpose of this study was to describe the incidence and risk factors for uterine sarcomas and parasitic myomas at the time of power morcellation.
We performed a retrospective review of 3523 women who underwent laparoscopic hysterectomy from 2001-2012. Univariate analyses were used for the morcellation cases to identify potential risk factors. Multivariable logistic regression was performed.
Nine hundred forty-one patients underwent power morcellation at the time of hysterectomy; 10 of 941 patients (1.1%) were diagnosed subsequently with uterine sarcomas or parasitic myomas. The overall incidence of uterine sarcoma was 6 of 941 (0.6%), with a median age of 47 years (range, 41-52 years). There was no association among any of the factors analyzed and uterine sarcoma. Three of 6 patients had sarcoma diagnosed on initial pathologic evaluation of the morcellated specimen; 3 patients had delayed diagnosis of sarcoma with benign disease at the time of the initial procedure (median time to second evaluation, 6 years). For parasitic myomas (n=4), the median age was 35 years (range, 32-40 years), and the median time to second evaluation was 5 years. On multivariate analysis, age<40 years (odds ratio, 26; 95% confidence interval, 2.7015-261.9; P≤.01) was associated with higher risk of the development of parasitic myomas.
Uterine sarcoma was found in 0.6% of patients who underwent power morcellation but was not found to be associated significantly with any preoperative factors. All 6 cases were noted to have apparent fibroid tumors as an indication for their hysterectomy. Age<40 years was a risk factor for parasitic myomas after power morcellation. Patients should be counseled about these complications before power morcellation.
本研究旨在描述能量粉碎术时子宫肉瘤和寄生性肌瘤的发生率及危险因素。
我们对2001年至2012年接受腹腔镜子宫切除术的3523名女性进行了回顾性研究。对粉碎术病例进行单因素分析以确定潜在危险因素。进行多变量逻辑回归分析。
941例患者在子宫切除术时接受了能量粉碎术；941例患者中有10例（1.1%）随后被诊断为子宫肉瘤或寄生性肌瘤。子宫肉瘤的总体发生率为941例中的6例（0.6%），中位年龄为47岁（范围41 - 52岁）。所分析的任何因素与子宫肉瘤之间均无关联。6例患者中有3例在粉碎标本的初始病理评估时被诊断为肉瘤；3例患者在初始手术时被误诊为良性疾病，随后被诊断为肉瘤（二次评估的中位时间为6年）。对于寄生性肌瘤（n = 4），中位年龄为35岁（范围32 - 40岁），二次评估的中位时间为5年。多变量分析显示，年龄<40岁（比值比，26；95%置信区间，2.7015 - 261.9；P≤0.01）与寄生性肌瘤发生风险较高相关。
接受能量粉碎术的患者中子宫肉瘤的发生率为0.6%，但未发现与任何术前因素有显著关联。所有6例均有明显的肌瘤作为子宫切除术的指征。年龄<40岁是能量粉碎术后发生寄生性肌瘤的危险因素。在进行能量粉碎术前应向患者告知这些并发症。
