Asgari Zahra, Enzevaei Anahita, Hosseini Reihaneh, Behnia-Willison Fariba
Department of Obstetrics and Gynaecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Senior endo-gynaecologist at Flinders Medical Centre and Senior lecturer at Flinders University, Adelaide, South Australia, Australia.
Aust N Z J Obstet Gynaecol. 2021 Oct;61(5):759-764. doi: 10.1111/ajo.13378. Epub 2021 Jun 1.
Specimen extraction is a major challenge in total laparoscopic hysterectomy (TLH) and tissue morcellation may be needed to extract a large uterus.
The study aims to determine preoperative factors that could predict the need for uterine morcellation in TLH, and also find the best cut-off values of each measured parameter leading to optimum sensitivity and specificity.
This was a cross-sectional study of women from August 2019 to May 2020 who underwent TLH, with or without salpingo-oophorectomy in our department. We performed bimanual exams preoperatively to estimate the uterine size and recorded the uterine ultrasonographic dimensions and myoma size in myomatous uteri. Receiver operating characteristic (ROC) were used to establish cut-offs that maximised the sensitivity and specificity of each factor in predicting the need for morcellation. Poisson regression was used to calculate the relative risks (RR) of each cut-off.
One hundred and sixty-two women were recruited in the study. ROC curves demonstrated maximum sensitivities and specificities with a cross-sectional area of 36.5 cm , the largest leiomyoma dimension of 40 mm, uterine length of 10 cm, and bimanual uterine size of 13 weeks. Multiple modified Poisson regression revealed that the strongest predictors of morcellation were the largest leiomyoma diameter of >40 mm (RR: 3.58), the uterine cross-sectional area of >36.5 cm (RR: 6.38), and uterine size in the bimanual exam of >13 weeks pregnancy (RR: 3.57).
The largest leiomyoma diameter, uterine cross-sectional area, and size on a bimanual exam can all be used to predict needing morcellation preoperatively in TLH.
标本取出是全腹腔镜子宫切除术（TLH）中的一项重大挑战，可能需要对大子宫进行组织粉碎术。
本研究旨在确定可预测TLH中子宫组织粉碎术需求的术前因素，并找出每个测量参数的最佳临界值，以实现最佳敏感性和特异性。
这是一项对2019年8月至2020年5月在我科接受TLH（无论是否行输卵管卵巢切除术）的女性进行的横断面研究。我们在术前进行双合诊检查以估计子宫大小，并记录子宫超声测量尺寸以及肌瘤子宫中的肌瘤大小。采用受试者工作特征（ROC）曲线来确定能使各因素预测组织粉碎术需求的敏感性和特异性最大化的临界值。使用泊松回归计算每个临界值的相对风险（RR）。
该研究共纳入162名女性。ROC曲线显示，当子宫横截面积为36.5平方厘米、最大平滑肌瘤直径为40毫米、子宫长度为10厘米以及双合诊子宫大小为13周时，敏感性和特异性达到最大值。多元修正泊松回归显示，组织粉碎术的最强预测因素为最大平滑肌瘤直径>40毫米（RR：3.58）、子宫横截面积>36.5平方厘米（RR：6.38）以及双合诊检查时子宫大小>13周妊娠（RR：3.57）。
最大平滑肌瘤直径、子宫横截面积以及双合诊检查时的子宫大小均可用于术前预测TLH中是否需要进行组织粉碎术。
