Impact of Myomas on the Results of Transcervical Resection of the Endometrium
Impact of Myomas on the Results of Transcervical Resection of the Endometrium
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DOI：
10.1016/j.jmig.2014.03.010
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发表时间：
2014-09-01
影响因子：
4.1
通讯作者：
Sorensen, Soren Stampe
中科院分区：
文献类型：
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作者：
Christoffersen, Christian;Kahr, Henriette Strom;Sorensen, Soren Stampe
研究目的：调查长期子宫切除率经子宫内膜切除术（TCRE）由经验丰富的外科医生在存在和不存在的intracavitary myomas.Design：多中心病例对照研究（加拿大工作组分类II-2）Patients：研究组包括456名妇女子宫肌瘤谁符合纳入标准，其中，82（17.98%）后来接受子宫切除术。对照组包括1438名妇女没有肌瘤，其中，284（19.75%）后来接受子宫切除术。方法：从2001年至2004年，标准化的结果，从Hyskobase提取的基础上，共有1894名妇女年龄在23至59岁。这些妇女被确定为有或没有肌瘤，并对两组的数据进行统计分析。肌瘤大小和肌壁间受累的详细信息（类型0、1和2）。测量和主要结果：TCRE后，发现与0型肌瘤相比，2型肌瘤的妇女接受子宫切除术的风险明显更高（p = 0.04），而女性，包括对照组，肌瘤最大直径>3.6 cm的患者行子宫切除术的风险明显高于肌瘤较小的患者（p = 0.01）。子宫切除术的风险在0型和1型肌瘤之间或1型和2型肌瘤之间没有统计学显著差异。当子宫肌瘤和对照组之间的子宫切除率进行比较时，对照组子宫切除的风险增加（p = 0.008）。TCRE的子宫和手术特征的多步多变量回归分析表明，切除术后66个月内子宫切除术的阳性预测因素是年龄较小，子宫角不可接近，子宫增大和使用促性腺激素释放激素激动剂的预处理。当对患有腔内肌瘤的女性进行TCRE时，如果它们是2型或直径>3.5 cm，则治疗成功的机会会更差。此外，年龄较小会增加子宫切除术的风险，并需要使用促性腺激素释放激素激动剂进行预处理，或者如果子宫增大或子宫角在手术过程中难以进入。(C)2014年AAGL。All rights reserved.
Study Objective: To investigate long-term hysterectomy rates after transcervical resection of the endometrium (TCRE) performed by experienced surgeons in the presence and absence of intracavitary myomas.Design: Multicenter case-control study (Canadian Task Force classification II-2).Patients: The study group comprised 456 women with myomas who met the inclusion criteria, and of these, 82(17.98%) later underwent hysterectomy. The control group comprised 1438 women without myomas, and of these, 284 (19.75%) later underwent hysterectomy.Methods: From 2001 to 2004, standardized results were extracted from Hyskobase on the basis of a total of 1894 women aged 23 to 59 years. The women were identified as having or not having myomas, and data from both groups were statistically analyzed. Detailed information on myoma size and intramural involvement (type 0, 1, and 2) was collected.Measurements and Main Results: After TCRE, women with type 2 myomas, compared with those with type 0 myomas, were found to have a significantly higher risk of undergoing hysterectomy (p = .04), and women, including controls, with myomas >3.6 cm in greatest diameter were found to have a significantly higher risk of undergoing hysterectomy than were those with smaller myomas (p = .01). There was no statistically significant difference in risk of hysterectomy between type 0 and type 1 myomas or between type 1 and type 2 myomas. When hysterectomy rates between the myoma and control groups were compared, there was an increased risk of hysterectomy in the control group (p = .008). Multiple-step multivariate regression analysis of uterine and procedural characteristics of TCRE demonstrated that factors that were positive predictors of hysterectomy within 66 months after resection were younger age, inaccessible uterine corners, enlarged uterus, and pretreatment using gonadotropin-releasing hormone agonists.Conclusion: When performing TCRE in women with intacavitary myomas, the chance of treatment success is worsened if they are of type 2 or their diameter is >3.5 cm. In addition, younger age increases the risk of hysterectomy and the need for pretreatment with gonadotropin-releasing hormone agonists, or if the uterus is enlarged or the uterine corners are difficult to access during the procedure. (C) 2014 AAGL. All rights reserved.