Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
Key Laboratory of Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, 610041, People's Republic of China.
Arch Gynecol Obstet. 2020 Jan;301(1):235-242. doi: 10.1007/s00404-019-05399-z. Epub 2019 Nov 28.
To determine whether or not the risk of recurrence of uterine leiomyoma (UL) was different between laparoscopic myomectomy (LM) and open myomectomy (OM).
This study combined a multicenter cohort study with a meta-analysis. The cohort study included women aged 18-44 years with 1-3 leiomyomas who underwent LM or OM for UL at one of three teaching hospitals. The meta-analysis included trials comparing recurrence rates of UL between OM and LM.
A total of 396 patients (LM: n = 83; OM: n = 313) were recruited in the cohort study. For women aged 18-44 years with 1-3 leiomyomas, surgical approach (LM vs. OM) was not an independent risk factor of UL recurrence (31.3% vs. 34.2%, P = 0.571), and the reoperation rate of UL was similar between the LM and OM (2.4% vs. 4.2%, P = 0.726). A total of 2566 patients were meta-analyzed. The recurrence of UL was similar between LM and OM when the patients had ≤ 5 leiomyomas (OR 1.10; 95% CI 0.76-1.61; P = 0.610; I = 0%), while the recurrence rate in LM group was higher when the patients had > 5 leiomyomas (OR 1.50; 95% CI 1.14-1.97; P = 0.004; I = 38%).
From the meta-analysis, the recurrence rate of UL was similar between LM and OM when the patients had ≤ 5 leiomyomas, while the recurrence of LM was higher when the number of leiomyomas was > 5. The cohort study partially supported this conclusion and it further proved the reoperation rate of UL was also similar among women aged 18-44 years with ≤ 3 leiomyomas. Therefore, OM should be considered for patients with > 3 or 5 leiomyomas if myomectomy has already been chosen.
确定腹腔镜子宫肌瘤剔除术（LM）和开腹子宫肌瘤剔除术（OM）治疗子宫肌瘤（UL）的复发风险是否不同。
本研究将多中心队列研究与荟萃分析相结合。该队列研究纳入了在三所教学医院接受 LM 或 OM 治疗 UL 的年龄在 18-44 岁、单发或多发 1-3 个肌瘤的女性。荟萃分析纳入了比较 OM 和 LM 治疗 UL 复发率的试验。
队列研究共纳入 396 例患者（LM 组：n=83；OM 组：n=313）。对于年龄在 18-44 岁、单发或多发 1-3 个肌瘤的女性，手术方式（LM 与 OM）不是 UL 复发的独立危险因素（31.3%比 34.2%，P=0.571），LM 和 OM 组 UL 的再次手术率相似（2.4%比 4.2%，P=0.726）。共对 2566 例患者进行了荟萃分析。当患者的肌瘤数≤5 个时，LM 和 OM 治疗 UL 的复发率相似（OR 1.10；95%CI 0.76-1.61；P=0.610；I²=0%），而当患者的肌瘤数>5 个时，LM 组的复发率更高（OR 1.50；95%CI 1.14-1.97；P=0.004；I²=38%）。
从荟萃分析来看，当患者的肌瘤数≤5 个时，LM 和 OM 治疗 UL 的复发率相似，而当肌瘤数>5 个时，LM 的复发率更高。队列研究部分支持了这一结论，并进一步证明了对于单发或多发 1-3 个肌瘤的 18-44 岁女性，UL 的再次手术率也相似。因此，如果已经选择了子宫肌瘤剔除术，对于肌瘤数>3 个或>5 个的患者，应考虑 OM。
