Department of Gynecology and Reproductive Endocrinology, Tonan Hospital, Sapporo, Japan.
Department of Obstetrics and Gynecology, Teikyo University School of Medicine.
J Obstet Gynaecol Res. 2023 Feb;49(2):675-681. doi: 10.1111/jog.15499. Epub 2022 Nov 20.
To evaluate the frequency of intrauterine adhesion (IUA) after hysteroscopic myomectomy, and to analyze the association of IUA and the location of submucous myomas and the use of postoperative barrier (POB).
Hysteroscopic myomectomy was performed in 217 patients with submucous myomas. The retrospective investigation was performed, and the cases were divided into three groups: cases with solitary submucous myoma (SSM; group 1), cases with apposing submucous myomas (ASMs; group 2) and cases with submucous myomas that were far from each other or not in apposition to one another (not apposing submucous myomas: NASMs; group 3). As POB, intrauterine device with oxidized regenerated cellulose and silicon sheet was inserted immediately after surgery.
IUA formation after hysteroscopic myomectomy was more frequent in group 2 than groups 1 and 3 (p = 0.03 and 0.01, respectively), despite the higher rates of POB use (p = 0.02). There was no significant difference in IUA formation in cases with POB between each group (p = 0.06 and 0.21, respectively). But in cases without POB, group 2 showed higher rates of IUA formation than group 1 (p = 0.04) and group 3 (p = 0.03). Multivariable analysis for IUA formation demonstrated that ASMs were a risk factor of IUA (hazard ratio [HR] = 27.9, p < 0.01), and the use of POB was a prognostic factor for reduction of IUA formation (HR = 0.08, p < 0.01).
ASMs appear to be a risk factor for IUA formation. The use of POB may be associated with preventing IUA formation after hysteroscopic myomectomy.
评估宫腔镜子宫肌瘤剔除术后宫腔粘连（IUA）的发生频率，并分析 IUA 与黏膜下肌瘤位置及术后使用屏障（POB）的关系。
对 217 例黏膜下肌瘤患者行宫腔镜子宫肌瘤剔除术。进行回顾性调查，将病例分为三组：单发黏膜下肌瘤组（SSM；组 1）、对吻型黏膜下肌瘤组（ASMs；组 2）和远离或不对吻型黏膜下肌瘤组（非对吻型黏膜下肌瘤：NASMs；组 3）。POB 采用氧化再生纤维素宫内节育器和硅酮片，术后立即放置。
尽管 POB 使用率较高（p=0.02），但宫腔镜子宫肌瘤剔除术后 IUA 形成在组 2 中比在组 1 和组 3 中更为常见（p=0.03 和 0.01）。在有 POB 的病例中，各组之间 IUA 形成率无显著差异（p=0.06 和 0.21）。但在无 POB 的病例中，组 2 的 IUA 形成率高于组 1（p=0.04）和组 3（p=0.03）。多变量分析显示，ASMs 是 IUA 形成的危险因素（风险比[HR] = 27.9，p<0.01），POB 的使用是降低 IUA 形成的预后因素（HR = 0.08，p<0.01）。
ASMs 似乎是 IUA 形成的危险因素。POB 的使用可能与宫腔镜子宫肌瘤剔除术后预防 IUA 形成有关。
