使用肌瘤假包膜保留技术的宫腔镜子宫肌瘤切除术后宫腔粘连的二次宫腔镜评估：一项回顾性比较研究

Postsurgical Intrauterine Adhesions after Hysteroscopic Myomectomy Using the Myoma Pseudocapsule Preservation Technique Evaluated bv Second-look Hysteroscopy: A Retrospective Comparative Study.

作者信息

Ikemoto Yuko, Nagai Saki, Tejima Kaoru, Saito Juichiro

机构信息

Department of Obstetrics and Gynecology, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University Faculty of Medicine, Tokyo, Japan.

出版信息

J Minim Invasive Gynecol. 2022 Aug;29(8):998-1002. doi: 10.1016/j.jmig.2022.05.004. Epub 2022 May 11.

DOI:10.1016/j.jmig.2022.05.004

PMID:35568332

Abstract

STUDY OBJECTIVE

To analyze the frequency and risk factors of postsurgical intrauterine adhesions (IUAs) using second-look hysteroscopy (SLH) in patients undergoing hysteroscopic myomectomy performed using the myoma pseudocapsule preservation technique for submucosal myoma.

DESIGN

Retrospective cohort study.

SETTING

University hospital from January 2017 to December 2019.

PATIENTS

A total of 124 patients underwent hysteroscopic myomectomy and SLH.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Surgical duration, intraoperative blood loss, number of enucleated myomas, volume of specimen, and postsurgical IUA evaluated by SLH. Postsurgical IUA were found in 5 of 124 cases (4.0%) at SLH. There were no cases of IUA formation in cases in which a single myomas was resected (0 of 83 cases, 0%); all cases were multiple myomas (5 of 41 cases, 12.2%), and IUA significantly occurred more frequently in cases of multiple myoma (p = .003). Univariate analyses showed that the IUA group contained a significantly larger number of enucleated uterine myoma (p <.001), required a longer operation (p = .003), and displayed an increased volume of intraoperative bleeding (p = .007), and the heavier the specimen, the greater the number of patients that had inserted an intrauterine device than the group that did not display postsurgical IUA. Multivariate logistic regression analysis of the risk factors of postsurgical IUA showed that the number of enucleated myomas was strongly associated with IUA (odds ratio, 1.45; 95% confidence interval, 1.06-1.97).

CONCLUSION

The frequency of postsurgical IUA after hysteroscopic myomectomy was high in cases of multiple myoma and may be a risk factor. SLH should be actively pursued in cases where the patient desires to bear children, and an informed consent should be attained before performing surgery.

摘要

研究目的

分析采用黏膜下肌瘤假包膜保留技术行宫腔镜子宫肌瘤切除术患者，通过二次宫腔镜检查（SLH）评估术后宫腔粘连（IUAs）的发生率及危险因素。

设计

回顾性队列研究。

地点

2017年1月至2019年12月期间的大学医院。

患者

共有124例行宫腔镜子宫肌瘤切除术及SLH的患者。

干预措施

无。

测量指标及主要结果

手术时间、术中出血量、摘除肌瘤数量、标本体积，以及通过SLH评估的术后IUA情况。在124例患者中，有5例（4.0%）在SLH时发现术后IUA。单发性肌瘤切除病例中无IUA形成病例（83例中的0例，0%）；所有IUA病例均为多发性肌瘤（41例中的5例，12.2%），多发性肌瘤病例中IUA的发生率显著更高（p = 0.003）。单因素分析显示，IUA组摘除的子宫肌瘤数量显著更多（p < 0.001），手术时间更长（p = 0.003），术中出血量增加（p = 0.007），且标本越重，与未发生术后IUA的组相比，放置宫内节育器的患者数量越多。对术后IUA危险因素的多因素逻辑回归分析显示，摘除肌瘤的数量与IUA密切相关（比值比，1.45；95%置信区间，1.06 - 1.97）。