Preutthipan S, Theppisai U
Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand.
J Med Assoc Thai. 1998 Mar;81(3):190-4.
We reported an initial result of the safety and efficacy of myomectomies performed between September 1994 and June 1997 by the hysteroscopic resectoscope in 50 patients at Ramathibodi Hospital. The indications for hysteroscopy and/or hysteroscopic myomectomy were menorrhagia in 23, metrorrhagia in 3, menometrorrhagia in 2, infertility with abnormal uterine bleeding in 12, abnormal uterine bleeding during hormonal replacement therapy (HRT) in 4, and suspected submucous myomas detected by ultrasonography and/or sonohysterography in 6 patients. The mean age of the 50 patients was 39.5 years with a range of 26 to 66 years. The sizes of the submucous myomas ranged from 1-5 cm. The mean of operation time was 32 minutes (range 15-60 minutes). The mean volume of 1.5 per cent glycine required for irrigation was 800 with a range of 600-2000 ml, and the mean deficit at the end of the operation was 300 with a range of 200-1000 ml. The mean estimation of blood loss during the operation was 80 ml with a range of 50-200 ml. Postoperatively 28 out of 30 patients with menorrhagia had improvement in excessive bleeding (93.33%). One patient underwent subsequent hysterectomy due to persistent heavy uterine bleeding from recurrent submucous myoma. All patients with infertility and patients under HRT had normal menstruation after this procedure. 2 out of 12 (16.67%) patients with infertility became pregnant after submucous resection. No serious complications occurred. One patient had a cervical laceration repaired by simple stitches. One patient had mild endometritis responding to outpatient antibiotics. Forty-eight patients were discharged from hospital the day after the operation, the remaining two staying overnight for observing post-operative bleeding. Our data suggested that resectoscopic myomectomy is a safe and effective surgical procedure. The procedure offers the advantage to the patients of a shorter hospital stay along with a low complication rate. The hysteroscopic approach to the symptomatic submucous myoma has dramatically changed the treatment options for patients who classically would be offered abdominal myomectomy or hysterectomy.
我们报告了1994年9月至1997年6月期间在拉玛蒂博迪医院，使用宫腔镜电切镜为50例患者实施子宫肌瘤剔除术的安全性和有效性的初步结果。宫腔镜检查和/或宫腔镜子宫肌瘤剔除术的适应证包括：月经过多23例、子宫不规则出血3例、月经过多与子宫不规则出血2例、伴有异常子宫出血的不孕症12例、激素替代治疗（HRT）期间的异常子宫出血4例、超声检查和/或子宫声学造影检查发现可疑黏膜下肌瘤6例。50例患者的平均年龄为39.5岁，年龄范围为26至66岁。黏膜下肌瘤大小为1 - 5厘米。平均手术时间为32分钟（范围15 - 60分钟）。冲洗所需的1.5%甘氨酸平均用量为800毫升（范围600 - 2000毫升），手术结束时平均液体缺失量为300毫升（范围200 - 1000毫升）。手术期间估计平均失血量为80毫升（范围50 - 200毫升）。术后，30例月经过多患者中有28例（93.33%）月经过多情况有所改善。1例患者因复发性黏膜下肌瘤导致持续性严重子宫出血，随后接受了子宫切除术。所有不孕症患者和接受HRT的患者在此手术后月经恢复正常。12例不孕症患者中有2例（16.67%）在黏膜下肌瘤切除术后怀孕。未发生严重并发症。1例患者宫颈裂伤，经简单缝合修复。1例患者发生轻度子宫内膜炎，门诊使用抗生素治疗有效。48例患者术后次日出院，其余2例留院观察术后出血情况。我们的数据表明，宫腔镜子宫肌瘤剔除术是一种安全有效的手术方法。该手术为患者提供了住院时间短、并发症发生率低的优势。对于有症状的黏膜下肌瘤，宫腔镜手术方法极大地改变了以往通常为患者提供开腹子宫肌瘤剔除术或子宫切除术的治疗选择。
