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肌瘤数量是机器人子宫肌瘤剔除术中失血和总手术时间的最重要风险因素:242例病例分析。

The Number of Myomas Is the Most Important Risk Factor for Blood Loss and Total Operation Time in Robotic Myomectomy: Analysis of 242 Cases.

作者信息

Lee Sa Ra, Kim Ju Hee, Kim Sehee, Kim Sung Hoon, Chae Hee Dong

机构信息

Asan Medical Center, Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Seoul 05505, Korea.

Asan Medical Center, Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Seoul 05505, Korea.

出版信息

J Clin Med. 2021 Jun 30;10(13):2930. doi: 10.3390/jcm10132930.

Abstract

To identify factors affecting blood loss and operation time (OT) during robotic myomectomy (RM), we reviewed a total of 448 patients who underwent RM at Seoul Asan Hospital between 1 January 2019, and 28 February 2021, at Seoul Asan Hospital. To avoid variations in surgical proficiency, only 242 patients managed by two surgeons who each performed >80 RM procedures during the study period were included in this study. All cases of RM were performed with a reduced port technique. We obtained the following data from each patient's medical chart: age, gravidity, parity, body mass index, and history of previous abdominal surgery including cesarean section. We also collected information on the maximal diameter and type of myomas, number and weight of removed myomas, concomitant surgery, total OT from skin incision to closure, estimated blood loss (EBL), and blood transfusion. Data on preoperative use of gonadotropin-releasing hormone agonists (GnRHas) and perioperative use of hemostatic agents (tranexamic acid or vasopressin) were also collected. Data on the length of hospital stay, postoperative fever within 48 h, and any complications related to RM were also obtained. The primary endpoint in this study was the identification of factors affecting EBL and the secondary endpoint was the identification of factors affecting the total OT during multiport RM. Univariate and multivariate analyses were used to identify the factors affecting EBL and OT during multiport RM. The medians of the maximal diameter and weight of the removed myomas were 9.00 (interquartile range [IQR], 7.00 to 10.00) cm and 249.75 (IQR, 142.88 to 401.00) g, respectively. The median number of myomas was two (IQR, one to four), ranging from 1 to 34. Of the cases, 155 had low EBL and 87 had high EBL. Most myomas were of the intramural type (n = 179). The odds of EBL > 320 mL increased by 251% (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.16-5.42) for five to nine myomas and by 647% (OR, 6.47; 95% CI, 1.87-22.33) for ≥10 myomas. The odds of subserosal-type myomas decreased by 67% compared with intramural-type myomas (OR, 0.33; 95% CI, 0.14-0.80). History of abdominal surgery other than cesarean section was positively correlated with EBL. The weight of the removed myomas and a history of previous cesarean section were not correlated with the EBL. : The number of myomas (5-9 and ≥10), maximal myoma diameter, and history of abdominal surgery other than cesarean section affect the EBL in RM.

摘要

为了确定影响机器人子宫肌瘤切除术(RM)中失血和手术时间(OT)的因素,我们回顾了2019年1月1日至2021年2月28日期间在首尔峨山医院接受RM的448例患者。为避免手术熟练程度的差异,本研究仅纳入了由两名在研究期间各自进行了超过80例RM手术的外科医生治疗的242例患者。所有RM病例均采用减少切口技术进行。我们从每位患者的病历中获取了以下数据:年龄、孕次、产次、体重指数以及包括剖宫产在内的既往腹部手术史。我们还收集了有关肌瘤的最大直径和类型、切除肌瘤的数量和重量、同期手术、从皮肤切口到缝合的总OT、估计失血量(EBL)和输血情况的信息。还收集了术前使用促性腺激素释放激素激动剂(GnRHas)和围手术期使用止血剂(氨甲环酸或血管加压素)的数据。还获取了住院时间、术后48小时内发热以及与RM相关的任何并发症的数据。本研究的主要终点是确定影响EBL的因素,次要终点是确定影响多端口RM期间总OT的因素。采用单因素和多因素分析来确定影响多端口RM期间EBL和OT的因素。切除肌瘤的最大直径和重量的中位数分别为9.00(四分位间距[IQR],7.00至10.00)cm和249.75(IQR,142.88至401.00)g。肌瘤数量的中位数为2个(IQR,1至4个),范围为1至34个。其中,155例患者EBL较低,87例患者EBL较高。大多数肌瘤为壁间型(n = 179)。肌瘤数量为5至9个时,EBL > 320 mL的几率增加了251%(比值比[OR],2.51;95%置信区间[CI],1.16至5.42),肌瘤数量≥10个时增加了647%(OR,6.47;95%CI,1.87至22.33)。浆膜下型肌瘤的几率与壁间型肌瘤相比降低了67%(OR,0.33;95%CI,0.14至0.80)。非剖宫产的腹部手术史与EBL呈正相关。切除肌瘤的重量和既往剖宫产史与EBL无关。:肌瘤数量(5至9个和≥10个)、最大肌瘤直径以及非剖宫产的腹部手术史会影响RM中的EBL。

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