子宫肌瘤剔除术后并发宫腔粘连危险因素分析及预测  

Analysis of the risk factors of the intrauterine adhesion after myomectomy and the predicting of these risk factors for theintrauterine adhesion

作　　者：陈影 严琴 王家莉 CHEN Ying;YAN Qin;WANG Jiali(Zhejiang Jinhua Guangfu Tumor Hospital,Jinhua,Zhejiang Province,321000)

机构地区：[1]浙江省金华广福肿瘤医院,321000

出　　处：《中国计划生育学杂志》2023年第7期1742-1745,1750,共5页Chinese Journal of Family Planning

摘　　要：目的:探讨子宫肌瘤剔除术后并发宫腔粘连的危险因素。方法:收集2020年6月—2022年6月本院收治的152例子宫肌瘤剔除术患者临床资料,观察术后宫腔粘连发生率。应用单因素与多因素logistic回归分析术后并发宫腔粘连影响因素,绘制受试者工作特征(ROC)曲线观察各独立危险因素联合预测术后并发宫腔粘连价值。结果:152例术后并发宫腔粘连27例(17.8%),其中重度粘连5例、中度粘连8例、轻度粘连14例。单因素分析,既往子宫手术史、最大肌瘤直径、最大肌瘤类型、手术入路、切开子宫腔均与子宫肌瘤剔除术后并发宫腔粘连有关(P<0.05);多因素分析显示,既往子宫手术史、手术入路为开腹、切开子宫腔为子宫肌瘤剔除术后并发宫腔粘连的独立危险因素(P<0.05);ROC曲线显示,既往子宫手术史、手术入路为开腹、切开子宫腔联合预测术后并发宫腔粘连的曲线下面积为0.696,95%CI 0.587~0.804,P=0.001。结论:患者有既往子宫手术史、手术入路为开腹、切开子宫腔使子宫肌瘤剔除术后并发宫腔粘连风险增加,临床应重点关注予以干预。Objective:To investigate the risk factors of intrauterine adhesion after myomectomy.Methods:The clinical data of 152patients with myomectomy from June 2020to June 2022were collected,and the incidence of the postoperative intrauterine adhesion of these patients was observed.Univariate and multivariate Logistic regression analysis were used to explore the influencing factors of the intrauterine adhesion after myomectomy.Receiver operator characteristic(ROC)curve was drawn to observe the predictive value of the combination of the independent risk factors of the patients for their postoperative intrauterine adhesion.Results:Among the 152patients,27(17.8%)cases had intrauterine adhesions,including 5cases with severe adhesions,8cases with moderate adhesions,and 14cases with mild adhesions.Univariate analysis showed that the previous history of uterine surgery,the maximum fibroid diameter,the maximum fibroid type,the surgical approach,and the incision of uterine cavity of the patients were correlated with their intrauterine adhesion after myomectomy(P<0.05).Multivariate analysis showed that the history of uterine surgery,the surgical approach with laparotomy,and the incision of uterine cavity of the patients were the independent risk factors of their uterine adhesions after myomectomy(P<0.05).ROC curve showed that the area under the curve of the combination of the previous history of uterine surgery,the surgical approach with laparotomy,and the incision of uterine cavity of the patients for predicting their postoperative uterine adhesion was 0.696(P=0.001,95%CI 0.587-0.804).Conclusion:The patients with the previous history of uterine surgery,with the surgical approach with laparotomy,or with the incision of uterine cavity have higher risk of intrauterine adhesion after myomectomy,which should be paid more attention to in clinical practice.

关 键 词：子宫肌瘤剔除术 宫腔粘连 危险因素 预测 

分 类 号：R737.33[医药卫生—肿瘤] R711.74[医药卫生—临床医学]