Transcervical Hysteroscopic Resection of Submucous Fibroids for Abnormal Uterine Bleeding: Results Regarding the Degree of Intramural Extension
Transcervical Hysteroscopic Resection of Submucous Fibroids for Abnormal Uterine Bleeding: Results Regarding the Degree of Intramural Extension
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经宫颈宫腔镜切除粘膜下肌瘤治疗异常子宫出血：关于壁内扩展程度的结果
DOI：
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发表时间：
1993
影响因子：
7.2
通讯作者：
J. D. de Kruif
中科院分区：
文献类型：
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作者：
K. Wamsteker;M. Emanuel;J. D. de Kruif
目的：探讨经宫颈黏膜下肌瘤切除术的效果与肌瘤壁内扩张程度的关系。方法：采用经宫颈粘膜下肌瘤切除术治疗子宫异常出血的前瞻性观察研究。平均随访20个月（10-34个月）。51例患者平均年龄38岁（范围23-55岁），根据粘膜下肌瘤的壁内扩张程度进行分类，经宫颈切除术治疗。目的是在对照宫腔镜下进行完全切除。除非患者拒绝进一步宫腔镜治疗，否则对不完全切除的病例进行重复手术。结果指标为出血控制、后续手术、手术次数、完全切除次数和复发次数。结果：术后48例（94.1%）患者出血得到控制。3例（5.9%）患者因持续抱怨而行子宫切除术：2例在完全切除后，1例在完全切除后。3例患者失访。其余45例患者（42例完全切除，3例不完全切除）中，3例（6.7%）复发（1例完全切除，2例不完全切除）。随着更广泛的内部受累，实现完全切除的机会减少，实现完全切除的平均手术次数增加。结论：完全切除可改善经宫颈黏膜下肌瘤切除术控制子宫异常出血的远期效果。经宫颈切除粘膜下肌瘤超过50%的腹壁内延伸应只在选定的情况下进行，因为完全切除通常需要重复手术。
Objective: To examine the results of transcervical resection of submucous fibroids in relation to the degree of intramural extension. Methods: A prospective 3-year observational study was performed of transcervical resection of submucous fibroids for abnormal uterine bleeding. The mean follow-up was 20 months (range 10-34). Fifty-one patients with a mean age of 38 years (range 23-55) were treated with transcervical resection after classification according to the degree of intramural extension of the submucous fibroids. The intention was to perform complete resection, established at control hysteroscopy. A repeat procedure was performed in cases of incomplete resection unless the patient denied further hysteroscopic treatment. Outcome measures were control of bleeding, subsequent surgery, number of procedures, number of complete resections, and number of recurrences. Results: Bleeding was controlled in 48 (94.1%) of all patients after final resection. Hysterectomy was performed in three patients (5.9%) because of persistent complaints: in two cases after incomplete resection and in one case after complete resection. Three patients were lost to follow-up. Of the remaining 45 patients (42 with complete and three with incomplete final resection), three (6.7%) had a recurrence (one after complete and two after incomplete final resection). With more extensive intramural involvement, the chance to achieve complete resection decreased and the mean number of procedures to achieve complete resection increased. Conclusions: Complete resection improves the long-term results of transcervical resection of submucous fibroids for control of abnormal uterine bleeding. Transcervical resection of submucous fibroids with more than 50% intramural extension should be performed only in selected cases, as complete resection usually necessitates repeat procedures.