Tanvir Tanvir, Garzon Simone, Alonso Pacheco Luis, Lopez Yarto Maite, Rios Mar, Stamenov Georgi, Moratalla Enrique, Shokeir Tarek, Adel Sedrati, Mikulasek Lubomir, Laganà Antonio Simone, Haimovich Sergio
Department of Obstetrics and Gynecology, Tanvir Hospital, Hyderabad, India.
Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy.
Eur J Obstet Gynecol Reprod Biol. 2021 Jan;256:358-363. doi: 10.1016/j.ejogrb.2020.11.048. Epub 2020 Nov 17.
To evaluate the feasibility and safety of leaving the submucous myoma (SM) in the uterine cavity after office hysteroscopic enucleation.
Prospective multicenter study including patients who had a single SM diagnosed by transvaginal ultrasounds with surgical indication. Office hysteroscopic enucleation of the SM was performed using a 5 mm continuous flow office hysteroscope with a 2.9 mm rod lens optical system and a 5 Fr operative channel. After the SM was released preserving the pseudo capsule using cold instruments, it was left into the uterine cavity. The primary endpoint was the proportion of patients without evidence of the myoma at the transvaginal ultrasound performed after 90 days from surgery.
Between January 1st, 2018, and March 31st, 2020, a total of 204 patients were enrolled. Most patients were nulliparous and reported abnormal uterine bleeding as the leading symptom. 76.5 % of enucleated myomas had a diameter ranging between 1.5 and 2.5 cm, and 81.4 % of SMs were of G0 or G1. Hysteroscopic procedures had a mean duration of 23.2 ± 10.5 min. The operative time was associated with the SM grade and size. All hysteroscopic procedures were completed. A vasovagal reaction was observed in 3 women (1.5 %), and minimal post-operative bleeding was reported after 7 procedures (3.4 %). None reported pelvic pain or vaginal discharges/bleeding during follow-up. The average patient satisfaction from surgery was 4.59 (5-points Likert scale). The level of patient satisfaction was not associated with the grade and the size of the myoma. In 192 (94.12 %; 98 %CI: 89.03-96.93 %) out of 204 patients, the SM was absent at the transvaginal ultrasound performed at the follow-up end. A higher prevalence of G2 SMs and lower prevalence of G1 SMs were observed among patients with evidence of the myoma after 90 days from the surgery.
Office hysteroscopic myomectomy with SM enucleation without mass extraction appears safe, well-tolerated, and effective in at least 89 % of patients. G2 SMs may be the factor associated with the procedure's failure.
评估门诊宫腔镜下子宫肌瘤剥除术后将黏膜下肌瘤（SM）留在宫腔内的可行性和安全性。
前瞻性多中心研究，纳入经阴道超声诊断为单个SM且有手术指征的患者。使用带有2.9mm棒状透镜光学系统和5Fr操作通道的5mm连续流动门诊宫腔镜对SM进行门诊宫腔镜下剥除术。使用冷器械在保留假包膜的情况下将SM剥除后，将其留在宫腔内。主要终点是术后90天经阴道超声检查未发现肌瘤的患者比例。
2018年1月1日至2020年3月31日，共纳入204例患者。大多数患者未生育，主要症状为异常子宫出血。76.5%的剥除肌瘤直径在1.5至2.5cm之间，81.4%的SM为G0或G1级。宫腔镜手术平均持续时间为23.2±10.5分钟。手术时间与SM分级和大小有关。所有宫腔镜手术均完成。3名女性（1.5%）出现血管迷走反应，7例手术（3.4%）术后有少量出血。随访期间无人报告盆腔疼痛或阴道分泌物/出血。手术患者平均满意度为4.59（5分制李克特量表）。患者满意度水平与肌瘤分级和大小无关。204例患者中，192例（94.12%；98%CI：89.03-96.93%）在随访结束时经阴道超声检查未发现SM。术后90天仍有肌瘤证据的患者中，G2 SM的患病率较高，G1 SM的患病率较低。
门诊宫腔镜下子宫肌瘤切除术剥除SM后不取出肿块似乎是安全的，耐受性良好，至少89%的患者有效。G2 SM可能是与手术失败相关的因素。
