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目的探讨宫腔镜电切术治疗子宫黏膜下肌瘤的临床效果及影响预后的相关因素。方法1999年1月至2004年11月,威海市妇女儿童医院对146例经宫腔镜联合超声检查发现子宫黏膜下肌瘤行宫腔镜肌瘤电切手术。其中0型40例,Ⅰ型55例,Ⅱ型51例。术前排除恶性病变。术中超声全程监护。术后连续随访。结果146例患者手术均顺利完成,所有0型、Ⅰ型黏膜下肌瘤均一次切净,Ⅱ型中有11例未能全部切除,切除范围≥70%。手术满意率达96·6%,无一例发生子宫穿孔。行米非司酮药物预处理2个月后子宫平均缩小25·3%,最大肌瘤平均缩小34·6%。14例有生育要求者,10例妊娠(71·4%),其中8例已足月分娩。结论宫腔镜电切术是治疗子宫黏膜下肌瘤的最佳方法。严格选择手术适应证,严格遵守操作规范是提高手术成功率,提高安全性及手术预后的关键因素。
Objective To investigate the clinical effects of hysteroscopic resection of uterine submucosal fibroids and related factors that affect prognosis. Methods From January 1999 to November 2004, Weihai Women and Children Hospital of 146 cases of hysteroscopic combined ultrasound examination of uterine fibroids found hysteroscopic fibroids resection. There were 40 cases of type 0, 55 cases of type Ⅰ and 51 cases of type Ⅱ. Preoperative exclusion of malignant lesions. Intraoperative ultrasound monitoring. Follow-up after surgery. Results The operation of 146 cases was successfully completed. All subtype 0 and type Ⅰ submucosal fibroids were excised in one time. In type Ⅱ, 11 cases failed to complete resection and the resection range was ≥70%. Surgical satisfaction rate was 96.6%, no case of uterine perforation. After 2 months of pretreatment with mifepristone, the uterus was reduced by 25.3% on average and the largest myoma was reduced by 34.6% on average. 14 cases had childbirth requirements, 10 cases of pregnancy (71.4%), of which 8 cases have full-term delivery. Conclusion Hysteroscopic resection is the best way to treat uterine submucous myoma. Strict selection of surgical indications, strict adherence to the rules of operation is to improve the success rate of surgery to improve the safety and prognosis of surgical key factors.