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过去15年有症状子宫肌瘤外科治疗的变化

The Changes of Surgical Treatment for Symptomatic Uterine Myomas in the Past 15 Years.

作者信息

Yang Weihong, Luo Ning, Ma Lishan, Dai Hong, Cheng Zhongping

机构信息

Department of Gynecology and Obstetrics, Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P.R.China.

Department of Gynecology, Gynecologic Minimally Invasive Surgery Research Center, Tongji University School of Medicine, Shanghai, P.R.China.

出版信息

Gynecol Minim Invasive Ther. 2018 Jan-Mar;7(1):10-15. doi: 10.4103/GMIT.GMIT_11_17. Epub 2018 Feb 16.

DOI:10.4103/GMIT.GMIT_11_17
PMID:30254928
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6135150/
Abstract

STUDY OBJECTIVE

The aim of this study is to elaborate the changes of the surgical approach of treatment for uterine myomas in Yangpu Hospital in the past 15 years.

DESIGN

This was retrospective cohort study.

SETTING

Yangpu Hospital, Tongji University School of Medicine, Shanghai, China.

MATERIALS AND METHODS

A total of 4113 patients with symptomatic uterine myomas underwent surgical treatments. Interventions: Eight kinds of different surgeries were involved in the study, including abdominal or laparoscopic surgery, hysterectomy, or uterus-sparing myomectomy.

MEASUREMENTS

The study collected patients' clinical data and reviewed surgical access and approach, complications, and the results of following up.

RESULTS

A total of 1559 cases (37.9%) underwent uterus-sparing myomectomy, 3005 cases (73.1%) performed laparoscopic surgeries. The percentage of laparoscopic surgery was significantly higher than homochronous data of laparotomy after 2003 ( < 0.001). The per year total of uterus-reserved surgery was proved to be negatively correlated with patient's age ( = 0.930; < 0.001). The rate of myomas recurrence was significantly lower in the combined myomectomy and uterine artery occlusion group (4%, 34/910) than in the single myomectomy group (10.5%, 44/420) ( < 0.001).

CONCLUSIONS

Retaining uterus and minimally invasive surgery were the important trends of surgical treatment for symptomatic uterine myomas. Laparoscopic uterus-sparing myomectomy may be an alternative to hysterectomy to manage to appropriate patients with uterine myomas.

摘要

研究目的

本研究旨在阐述杨浦医院过去15年子宫肌瘤治疗手术方式的变化。

设计

这是一项回顾性队列研究。

地点

中国上海同济大学医学院附属杨浦医院。

材料与方法

共有4113例有症状的子宫肌瘤患者接受了手术治疗。干预措施：研究涉及八种不同的手术，包括开腹或腹腔镜手术、子宫切除术或保留子宫的肌瘤切除术。

测量指标

本研究收集了患者的临床资料，并回顾了手术入路和方式、并发症及随访结果。

结果

共有1559例（37.9%）患者接受了保留子宫的肌瘤切除术，3005例（73.1%）患者进行了腹腔镜手术。2003年后腹腔镜手术的比例显著高于同期开腹手术的数据（<0.001）。保留子宫手术的年总数与患者年龄呈负相关（r = 0.930；<0.001）。肌瘤切除术联合子宫动脉栓塞组的肌瘤复发率（4%，34/910）显著低于单纯肌瘤切除术组（10.5%，44/420）（<0.001）。

结论

保留子宫和微创手术是有症状子宫肌瘤手术治疗的重要趋势。腹腔镜下保留子宫的肌瘤切除术可能是子宫切除术的一种替代方法，适用于合适的子宫肌瘤患者。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/592a/6135150/74e282796523/GMIT-7-10-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/592a/6135150/001deb6e7b70/GMIT-7-10-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/592a/6135150/5da02b511f9f/GMIT-7-10-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/592a/6135150/1c0ac6ba0ce7/GMIT-7-10-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/592a/6135150/74e282796523/GMIT-7-10-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/592a/6135150/001deb6e7b70/GMIT-7-10-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/592a/6135150/5da02b511f9f/GMIT-7-10-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/592a/6135150/1c0ac6ba0ce7/GMIT-7-10-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/592a/6135150/74e282796523/GMIT-7-10-g004.jpg

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