Whipps Cross University Hospital, Barts Health NHS Trust, London, U.K.
Women's Health Research Unit, Queen Mary University of London, London, U.K.
In Vivo. 2020 Mar-Apr;34(2):695-701. doi: 10.21873/invivo.11826.
Leiomyomas are common in women of reproductive age, for whom treatment-stratification can be challenging. We assessed factors influencing pre-operative selection of surgical intervention and compare outcomes.
A literature review was performed and surgical interventions for fibroids at a London hospital (2015-2018) were retrospectively examined. Outcomes assessed were estimated blood loss, length of stay (LOS) and complications. Data were analysed using univariate non-parametric inferential statistics.
A total of 258 cases were identified. Estimated blood loss was statistically significantly lower for laparoscopic versus open myomectomy [200 (interquartile range; IQR)=100-200 vs. 400 (IQR=200-700 ml), p<0.001]. Length of stay was also statistically significantly lower in the laparoscopic cohort compared with open hysterectomy [1 (IQR=1-1) days vs. 2 (IQR=2-3 days)]. Similar results were noted when comparing laparoscopic versus open hysterectomy [167 (IQR=100-200) vs. 500 (IQR=100-750) ml, p<0.001]. No differences in complications were reported across groups. Patients counselled by a surgeon trained in minimally invasive surgery (MIS) opted more frequently for laparoscopy (p<0.01, rho=-0.669). Estimated blood loss during MIS was 225 ml versus 545 ml for non-MIS, and 285 ml for the overall cohort (p<0.01).The length of stay was statistically significantly lower for those treated with MIS (1.37 days) versus other surgeons (2.65 days), or overall cohort (1.63 days) (p<0.01 for all associations).
Laparoscopic surgery offers superior short-term outcomes when performed by experienced operators. Multidisciplinary counselling and treatment stratification should be gold-standard practice. Centralisation of care provision in fibroid Centres of Excellence is required.
子宫肌瘤在育龄妇女中很常见，对她们进行治疗分层具有挑战性。我们评估了影响术前选择手术干预的因素，并比较了结果。
对伦敦一家医院（2015-2018 年）的子宫肌瘤手术进行了文献回顾，并对其进行了回顾性检查。评估的结果是估计失血量、住院时间（LOS）和并发症。使用单变量非参数推断统计数据进行数据分析。
共确定了 258 例病例。腹腔镜与开腹子宫肌瘤切除术的估计失血量有统计学显著差异[200（四分位距；IQR=100-200 与 400（IQR=200-700ml），p<0.001]。与开腹子宫切除术相比，腹腔镜组的 LOS 也有统计学显著降低[1（IQR=1-1）天与 2（IQR=2-3 天）]。当比较腹腔镜与开腹子宫切除术时，也观察到类似的结果[167（IQR=100-200）与 500（IQR=100-750）ml，p<0.001]。各组间报告的并发症无差异。接受微创外科（MIS）培训的外科医生咨询的患者更频繁地选择腹腔镜手术（p<0.01，rho=-0.669）。MIS 时的估计失血量为 225ml，而非 MIS 时为 545ml，总体队列时为 285ml（p<0.01）。接受 MIS 治疗的患者的 LOS 明显低于其他外科医生（2.65 天）或总体队列（1.63 天）（所有关联均 p<0.01）。
有经验的医生进行腹腔镜手术可获得更好的短期结果。多学科咨询和治疗分层应作为标准实践。需要在肌瘤卓越中心集中提供护理服务。
