Hatırnaz Şafak, Güler Oğuz, Başbuğ Alper, Çetinkaya Mehmet Bilge, Kanat-Pektaş Mine, Bakay Kadir, Çelik Samettin, Şentürk Şenol, Soyer-Çalışkan Canan, Gürçağlar Aysemin, Şahin Banuhan, Kalkan Üzeyir, Çelik Handan, Kalyoncu Şenol, Bıyık İsmail, Yassa Murat, Erol Onur, Akarsu Süleyman, Turhan Uğur, Ulubaşoğlu Hasan, Sparic Radmila, Tinelli Andrea
Medicana Samsun International Hospital, IVF Center, Sansun, Turkey.
Department of Obstetrics and Gynecology, Bilge Hastanesi, Istanbul, Turkey.
J Invest Surg. 2021 Jul;34(7):687-694. doi: 10.1080/08941939.2020.1725188. Epub 2020 Feb 17.
This multi-center study aims to determine the efficiency and safety of endometrial myomectomy (EM) for the removal of uterine fibroids during cesarean section (CS).
Retrospective review of 360 women diagnosed for fibroids during pregnancy. They all delivered by CS between 2014 and 2019. The study groups included 118 women who only underwent EM, 120 women who only had subserosal myomectomy by traditional technique and 122 women with fibroids who decided to avoid cesarean myomectomy, as control group. They were analyzed and compared the surgical outcomes.
The EM, subserosal myomectomy and control groups were statistically ( > 0.05) similar for to age, body mass index (BMI), gravidity, parity, gestational age at delivery, indications for CS, number of excised fibroids, size of the largest myoma. Postoperative hemoglobin values and ? (?) hemoglobin concentrations were lower in SM group (10.39gr/dl vs 9.98 gr/dl vs 10.19 - 1.44 gr/dl vs 1.90 gr/dl vs 1.35; = 0.047, = 0.021; respectively) Hybrid fibroids were significantly more frequent in the EM group than subserosal myomectomy and control groups (respectively, 33.1% vs 23.3% vs 27.0%, = 0.002). Surgery time was significantly longer in the subserosal myomectomy group than EM and control groups (respectively, 46.53 min vs 37.88 min vs 33.86 min, = 0.001). Myomectomy took significantly longer time in the subserosal myomectomy than EM group (13.75 min vs 8.17 min, = 0.001).
Endometrial myomectomy is a feasible choice for treatment of fibroids during CS, and, basing on our results could be an alternative to traditional cesarean subserosal myomectomy.
本多中心研究旨在确定剖宫产术中子宫内膜肌瘤切除术（EM）切除子宫肌瘤的有效性和安全性。
回顾性分析360例孕期诊断为子宫肌瘤的女性。她们均于2014年至2019年间行剖宫产分娩。研究组包括118例仅接受EM的女性、120例仅采用传统技术行浆膜下肌瘤切除术的女性以及122例决定避免剖宫产肌瘤切除术的子宫肌瘤女性作为对照组。对她们的手术结果进行分析和比较。
EM组、浆膜下肌瘤切除术组和对照组在年龄、体重指数（BMI）、妊娠次数、产次、分娩时孕周、剖宫产指征、切除肌瘤数量、最大肌瘤大小方面差异无统计学意义（P>0.05）。浆膜下肌瘤切除术组术后血红蛋白值和血红蛋白浓度低于EM组（分别为10.39g/dl对9.98g/dl对10.19 - 1.44g/dl对1.90g/dl对1.35；P = 0.047，P = 0.021）。EM组混合性肌瘤的发生率显著高于浆膜下肌瘤切除术组和对照组（分别为33.1%对23.3%对27.0%，P = 0.002）。浆膜下肌瘤切除术组的手术时间显著长于EM组和对照组（分别为46.53分钟对37.88分钟对33.86分钟，P = 0.001）。浆膜下肌瘤切除术切除肌瘤的时间显著长于EM组（13.75分钟对8.17分钟，P = 0.001）。
子宫内膜肌瘤切除术是剖宫产术中治疗子宫肌瘤的一种可行选择，基于我们的结果，它可能是传统剖宫产浆膜下肌瘤切除术的一种替代方法。
