宫腔镜手术治疗早期弥漫性子宫肌瘤病临床分析  

Analysis on the surgical and reproductive outcomes of early diffuse uterine leiomyomatosis with hysteroscopic myomectomy

作　　者：黄晓武[1] 夏恩兰[1] 马宁[1] 彭雪冰[1] 肖豫[1] 

机构地区：[1]首都医科大学附属复兴医院妇产科,北京100038

出　　处：《中国内镜杂志》2012年第6期581-584,共4页China Journal of Endoscopy

基　　金：北京市优秀人才培养资助经费(No.20061D0900700366)

摘　　要：目的研究宫腔镜手术治疗早期弥漫性子宫平滑肌瘤病(DUL)的临床效果及生殖预后。方法 31例因月经过多合并贫血和(或)不孕症的生育年龄患者,经阴道超声和宫腔镜检查证实为DUL,在超声监护下行宫腔镜手术,切除宫腔内及壁间内突肌瘤,保留壁间肌瘤。随访手术后宫腔内膜修复情况、宫腔粘连形成情况、复发率、术后妊娠率及活产率。结果 31例患者平均随访(31.7±11.0)个月,6例患者行2次经宫颈子宫肌瘤切除术(TCRM),3例患者行3次TCRM,除1例患者术后月经改善效果不佳行腹腔镜下次全子宫切除术,其余30例患者均保留子宫。术后2～3个月子宫内膜修复,月经改善率为93.5%(29/31),复发率为32.3%(10/31),一次手术后宫腔粘连率为45.1%(14/31),19例不孕症患者术后妊娠率52.6%(10/19)、活产率为47.4%(9/19)。结论宫腔镜手术可替代传统手术治疗早期DUL,可改善月经,保留子宫,保留患者生育力。[ Objective ] To analyze the surgical and reproductive outcomes of early diffuse uterine leiomyomato- sis with hysteroscopy myomeetomy. [ Methods ] 31 women of reproductive age suffered from menorrhagia combined with anemia or infertility were diagnosed as diffuse uterine myomatosis by ultrasonography and hysteroscopy, hys- teroscopic myomectomy were performed to excise only myomas impinging into the endometrial cavity, while leaving other intramural myomas in place. Postoperative endometrium repair and synechiae, recurrence, menstrual amount, conception, and pregnancy outcome were followed up. [ Results ] Among the total 31 patients, 6 experienced repeat- ed myomectomy and 3 experienced myomectomy 3 times because of submucosal myoma recurrence. Recurrence rate was 32.3% （10/31）. The uterus was successfully preserved for 30 patients except one laparoscopic subtotal hysterec- tomy, a normal amount of menstruation was restored in 93.5% （29/31） patients. 45.1% （14/31） patients had postoper- ative synechiae after first hysteroscopic surgery, 19 patients who wished to conceive had 10 successful conceptions, with 9 healthy deliveries, the postoperative pregnancy rate was 52.6%,and live birth rate was 47.4% （9/19）. [ Con- clusion] Women with early-stage diffuse uterine leiomyomatosis can be treated by hysteroscopic resection, which has the benefits of preserving the uterus successfully and yielding satisfactory reproductive outcomes.

关 键 词：弥漫性子宫肌瘤病 宫腔镜手术 生殖预后 

分 类 号：R711.74[医药卫生—妇产科学]