宫腔镜下冷刀切除黏膜下肌瘤优势的初步探讨  

Preliminary study on the advantages of hysteroscopic myomectomy with cold knife

作　　者：李外星 邹凌霄[1] 顾盼 于洋[1] 张爱倩 徐大宝[1] LI Waixing;ZOU Lingxiao;GU Pan;YU Yang;ZHANG Aiqian;XU Dabao(Department of Gynecology,Third Xiangya Hospital,Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院妇科,长沙410013

出　　处：《中南大学学报（医学版）》2022年第11期1593-1599,共7页Journal of Central South University ：Medical Science

基　　金：湖南省自然科学基金(2021JJ40953)。

摘　　要：目的:目前国内外的宫腔镜黏膜下子宫肌瘤切除术多采用宫腔镜电切除术(以下简称电刀),术中产生的电热效应不仅损伤黏膜下子宫肌瘤表面覆盖的内膜,也易损伤子宫肌瘤周围的内膜组织,这对于有生育要求的患者不利。此外,对于一些特殊部位(宫角和宫底部)或者II型和多发的黏膜下子宫肌瘤等情况,传统的电刀手术处理仍然非常棘手。随着中国二胎政策的开放,对生育力保护的观念逐渐重视,宫腔镜冷刀切除术(以下简称冷刀)也逐渐走进人们的视野,冷刀具有操作简便、创伤小、术后恢复快等优点。本研究通过对比宫腔镜下冷刀及电刀切除黏膜下子宫肌瘤的安全性及有效性,探讨冷刀在黏膜下子宫肌瘤手术切除方面的优势。方法:回顾性分析2017年1月至2021年10月在中南大学湘雅三医院诊断并经宫腔镜手术切除的112例黏膜下子宫肌瘤患者的相关临床资料,包括术前一般资料(如年龄,孕次,流产次数,黏膜下子宫肌瘤大小、位置、类型、数量和术前血红蛋白值等)以及术中情况[如术中出血量、手术时间、手术残留率和术中并发症(大出血、穿孔、水中毒等)]。患者分为宫腔镜下冷刀切除黏膜下子宫肌瘤组(冷刀组)及宫腔镜下电刀切除黏膜下子宫肌瘤组(电刀组),其中冷刀组40例,电刀组72例,并电话随访两组术后的情况,包括术后复发、术后并发症、妊娠率、妊娠方式、妊娠结局等。结果:与电刀组相比,冷刀组位于子宫角或子宫底的黏膜下子宫肌瘤的比例更多(分别为9.7%和25.0%),II型或合并有II型的子宫肌瘤也更多(分别为26.4%和70.0%)。但两组术中出血、手术时间、术中并发症及术后残留率的差异均无统计学意义(均P>0.05)。术后共随访到98例患者,其中冷刀组32例,电刀组66例。与电刀组相比,冷刀组术后并发症的发生率更低(分别为37.9%和12.5%,P<0.05)。在7例多发黏膜下子宫Objective:At present,hysteroscopic submucosal fibroids resection is mostly performed by hysteroscopic electric resection(hereinafter referred to as electric knife).During the operation,the electrothermal effect could not only damage the endometrial tissues covered by the surface of the fibroid,but also easily damage the endometrial tissues around the fibroid,which is very unfavorable for patients with fertility requirements.In addition,for some special fibroids(located at horn and fundus)or Type II and multiple submucosal fibroids,the traditional electric resection is still very difficult.With the opening of the second-child policy and the urgent desire of patients for fertility,more and more attention is paid to the concept of fertility protection in China.Therefore,hysteroscopic cold knife technology(hereinafter referred to as cold knife)has gradually entered the vision.The cold knife has the advantages of simple operation,such as little trauma and quick postoperative recovery.In this study,the advantages of cold knife in the surgical resection of submucosal fibroids are discussed by comparing the safety and effectiveness between the hysteroscopic cold knife resection(hereinafter referred to as cold knife)and the electric knife resection in the submucosal fibroids.Methods:The clinical data of 112 patients with submucosal fibroids diagnosed and treated by hysteroscopic surgery at the Third Xiangya Hospital of Central South University from January 2017 to October 2021 were retrospectively analyzed,including preoperative general information(such as age,gravidity,abortion times,the size,location,type and number of submucosal fibroids,preoperative hemoglobin value)and intraoperative conditions[such as intraoperative bleeding,the operation time,residual rates and intraoperative complications(massive bleeding,perforation,water poisoning)].The patients were divided into a cold knife group and an electric knife group,and there were 40 cases in the cold knife group and 72 cases in the electric knife group.The postoperati

关 键 词：宫腔镜 冷刀切除术 电切除术 黏膜下子宫肌瘤 并发症 

分 类 号：R737.33[医药卫生—肿瘤]