Zhang Wenjia, French Hannah, O'Brien Mollie, Movilla Peter, Isaacson Keith, Morris Stephanie
Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts (all authors).
Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts (all authors).
J Minim Invasive Gynecol. 2023 Oct;30(10):805-812. doi: 10.1016/j.jmig.2023.05.013. Epub 2023 May 27.
To study the incidence of intrauterine adhesions (IUAs) after hysteroscopic myomectomy. Previous studies report a range of incidence for IUAs after hysteroscopic myomectomy.
A retrospective review study.
An academic community hospital in the Boston metropolitan area.
Patients undergoing hysteroscopic myomectomy at our institution from January 2019 to February 2022. Patients were excluded if they did not have plans for future fertility or had a new diagnosis of cancer.
All patients underwent hysteroscopic myomectomy using bipolar resectoscope without postoperative medical or barrier treatment. All procedures were performed by 1 of 4 fellowship-trained high-volume gynecologic surgeons with resident and fellow assistance. Incidence of postoperative IUAs was assessed and treated using second-look office hysteroscopy.
A total of 44 patients without preoperative IUAs underwent hysteroscopic myomectomy during our study period, and 4 patients (9.1%) developed new IUAs. Among 9 patients who were found to have preoperative IUAs and underwent concurrent hysteroscopic myomectomy and lysis of adhesions, we found a recurrence of IUAs in 5 patients (55.6%). We found the number, size, and deepest type of myoma removed were not correlated to an increased risk of new IUA formation. In addition, removing myomas on opposing walls during the same operation did not increase the incidence of new IUAs.
Formation of IUAs after hysteroscopic myomectomy is a well-documented consequence. Our reported incidence of 9.1% of new IUAs that are not affected by the number, size, deepest type of myoma resected, and resection of myomas on opposing uterine walls contributes to the current literature. In addition, our finding of 55.6% of recurrent IUAs in patients undergoing both hysteroscopic myomectomy and lysis of adhesions highlights a high-risk population requiring additional study.
研究宫腔镜下子宫肌瘤切除术后宫腔粘连（IUA）的发生率。既往研究报道了宫腔镜下子宫肌瘤切除术后IUA的发生率范围。
一项回顾性研究。
波士顿都会区的一家学术社区医院。
2019年1月至2022年2月在我们机构接受宫腔镜下子宫肌瘤切除术的患者。如果患者没有未来生育计划或新诊断为癌症，则将其排除。
所有患者均使用双极电切镜进行宫腔镜下子宫肌瘤切除术，术后未进行药物或屏障治疗。所有手术均由4名接受过 fellowship 培训的高年资妇科外科医生之一在住院医师和进修医生的协助下进行。术后IUA的发生率通过二次宫腔镜检查进行评估和治疗。
在我们的研究期间，共有44例术前无IUA的患者接受了宫腔镜下子宫肌瘤切除术，4例（9.1%）出现了新的IUA。在9例术前发现有IUA并同时接受宫腔镜下子宫肌瘤切除术和粘连松解术的患者中，我们发现5例（55.6%）出现了IUA复发。我们发现切除的肌瘤数量、大小和最深类型与新IUA形成风险增加无关。此外，在同一手术中切除相对壁上的肌瘤并不会增加新IUA的发生率。
宫腔镜下子宫肌瘤切除术后IUA的形成是一个有充分文献记载的后果。我们报道的9.1%的新IUA发生率不受切除肌瘤的数量、大小、最深类型以及子宫相对壁上肌瘤切除的影响，这为当前文献提供了补充。此外，我们发现在接受宫腔镜下子宫肌瘤切除术和粘连松解术的患者中，55.6%的患者出现IUA复发，这突出了一个需要进一步研究的高危人群。
