Şükür Yavuz E, Kankaya Duygu, Ateş Can, Sertçelik Ayşe, Cengiz Sevim D, Aytaç Ruşen
Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey.
Department of Pathology, Ankara University School of Medicine, Ankara, Turkey.
Int J Gynaecol Obstet. 2015 Apr;129(1):75-8. doi: 10.1016/j.ijgo.2014.10.023. Epub 2014 Dec 17.
To assess clinical and histopathologic risk factors for reoperation after laparotomic myomectomy due to leiomyoma recurrence.
A case-control study was conducted of patients who underwent their first myomectomy for leiomyoma without receiving gonadotropin-releasing hormone analogues at Ankara University School of Medicine, Ankara, Turkey, between January 2000 and December 2004. Medical records and histopathologic samples were reviewed, and participants completed a telephone interview. Patients in the case group had undergone reoperation within 5 years; those in the control group had not required further surgery.
There were 51 patients in the case group and 61 controls. The number of women who had given birth after the index surgery was lower among cases than controls (4 [7.8%] vs 13 [21.3%]; P=0.048), as was the median size of the largest leiomyoma removed (4 cm [range 3-10] vs 5 cm [range 3-25]; P=0.009). Reoperation was more likely among patients aged at least 40 years at index surgery (OR 1.10; 95% CI 1.18-7.78; P=0.021) and those with myxoid change (OR 2.04; 95% CI 1.07-55.41; P=0.043). The number of leiomyomas removed was negatively associated with reoperation (OR 0.30; 95% CI 0.58-0.93; P=0.012).
Young age, removal of many or large leiomyomas, and pregnancy after myomectomy decreased reoperation risk, whereas myxoid change increased risk.
评估因平滑肌瘤复发而接受剖腹子宫肌瘤切除术后再次手术的临床和组织病理学危险因素。
对2000年1月至2004年12月期间在土耳其安卡拉大学医学院因平滑肌瘤接受首次子宫肌瘤切除术且未接受促性腺激素释放激素类似物治疗的患者进行病例对照研究。回顾了病历和组织病理学样本，并对参与者进行了电话访谈。病例组患者在5年内接受了再次手术；对照组患者无需进一步手术。
病例组有51例患者，对照组有61例。病例组中指数手术后分娩的女性人数低于对照组（4例[7.8%]对13例[21.3%]；P=0.048），切除的最大平滑肌瘤的中位数大小也低于对照组（4厘米[范围3 - 10厘米]对5厘米[范围3 - 25厘米]；P=0.009）。指数手术时年龄至少40岁的患者再次手术的可能性更大（OR 1.10；95%CI 1.18 - 7.78；P=0.021），以及有黏液样改变的患者（OR 2.04；95%CI 1.07 - 55.41；P=0.043）。切除的平滑肌瘤数量与再次手术呈负相关（OR 0.30；95%CI 0.58 - 0.93；P=0.012）。
年轻、切除多个或大的平滑肌瘤以及子宫肌瘤切除术后怀孕可降低再次手术风险，而黏液样改变会增加风险。
