子宫肌瘤切除术后复发情况及其复发危险因素的分析
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摘要
目的:子宫肌瘤是女性生殖器官最常见的一种良性肿瘤,多发生于育龄妇女,且发病率呈逐年上升趋势,严重危害女性的身心健康。临床上中医、西医药物治疗子宫肌瘤均有不错的疗效,但一般不能使肌瘤得到根治或消除,对于症状明显、药物治疗无明显效果的患者,手术仍是子宫肌瘤的主要治疗手段。随着人们对生活质量要求的提高和微创技术的发展,越来越多的肌瘤患者为保留子宫而选择行子宫肌瘤切除术的手术方式。但据国内外文献报道,子宫肌瘤切除后肌瘤的复发率较高。复发原因现在认为患者存在某种肌瘤好发因素,或是术中遗留微小肌瘤。本研究是通过调查子宫肌瘤切除术后情况及复发率,统计不同中医证型的患者复发率有无差别,分析相关内容,探讨子宫肌瘤切除术后复发的危险因素。
方法:回顾性研究分析2000年1月至2005年12月在广州中医药大学第一附属医院妇科行子宫肌瘤切除术患者82例,回访调查复发例数及相关情况,根据中医辨证分成气滞血瘀、肾虚血瘀证两组进行比较。
结果:复发19例,复发率为23.17%。复发时间距手术平均为32.68个月(6个月-66个月)。术前B超检查发现肌瘤数平均1.82个(1个—6个),单发性44例(53.66%),多发性38例(46.34%);术中摘除肌瘤平均肌瘤数2.83个(1个—43个),术中所见为单发肌瘤38例(46.34%),多发肌瘤44例(53.66%);最大肌瘤直径平均5.63cm(1.00cm-15.00cm)。气滞血瘀证44例,复发9例(20.45%);肾虚血瘀证38例,复发10例(26.32%)。复发与术前妊娠史、家族史、临床症状、中医辨证分型、肌瘤的大小、生长部位、手术方式、病理、肌瘤是否变性、术后治疗及术后妊娠史等无明显相关性(P＞0.05),与年龄、子宫肌瘤个数有相关性。
结论:(1)本研究中82例子宫肌瘤切除术后患者复发19例,复发率为23.17%。发现复发时间距手术平均为32.68个月,符合文献报道。其中气滞血瘀证44例,复发9例,复发率为20.45%,肾虚血瘀证38例,复发10例,复发率为26.32%,两者无显著性差异。
(2)本研究中术前B超检查发现肌瘤数平均1.82个,术中摘除肌瘤平均肌瘤数2.83个,显示术中发现的肌瘤数量比术前B超发现的多,可推测部分患者存在不能被B超发现的微小肌瘤。
(3)本研究显示年龄、子宫肌瘤个数与肌瘤复发有相关性,手术年龄＜40岁和多发性子宫肌瘤者为子宫肌瘤切除术后复发的危险因素。术前B超检查发现单发性子宫肌瘤44例,复发4例,复发率为9.09%,多发性子宫肌瘤38例,复发15例,复发率39.47%,有显著性差异性(P=0.001)。术中发现为单发性子宫肌瘤38例,复发3例,复发率为7.89%;术中发现为多发性子宫肌瘤44例,复发16例,复发率36.36%,有显著性差异(P=0.002)。手术时年龄＜40岁者57例,复发17例,复发率为29.82%。年龄≥40岁者25例,复发2例,复发率为8.00%,有显著性差异(P=0.031)。
(4)子宫肌瘤切除术后复发与术前妊娠史、家族史、临床症状、中医辨证分型、肌瘤的大小、生长部位、手术方式、病理、肌瘤是否变性、术后治疗及术后妊娠史等无明显相关性(P＞0.05)
Objective: Uterine myoma is one kind of the most common benign tumor of female genital organ, which always occurs in women of childbearing age. And the morbidity increases year by year. This disease is seriously hazardous to women' health. Treating uterine myoma by Chinese medicince or Western medicine drug all gets good effects, but the treatment of medicine cannot be completely cure the uterine myoma for all. Surgery is still the main treatment for some patients who have no significant effects for medicine. As the quality of people' s life improves and the technique of minimally invasive develops, more and more patients who want to retain uterus will choose the Myomectomy. According to the litrature, recurrent rate of myomectomy is high. It thinks that people have some factors which may cause uterine myoma growth, or left small uterine myoma in surgery. This research is according to surveying the situation of the patients underwent myomectomy and the recurrent rate, analyze the risk factors of recurrence of uterine myoma after myomectomy, and find the differences of the recurrent rate and the risk factors between the two different types of Traditional Chinese Medicine of the patients underwent myomectomy.
Methqds:82 cases underwent myomectomy in the Guangzhou University of Traditional Chinese Medicine Hospital form Jan 1,2000 to Dce 31,2005 were analyzed with retrospective study. According to differentiation for syndrome classification, divide the cases into two groups (liver-qi stagnation and blood stasis, kidney deficiency and blood stasis) to compare.
Results: 19 cases were recurrent. The recurrent rate was 23.17%. The average time of recurrence was 32. 68 months after myomectomy. The average number of uterine myoma found by ultrasonography was 1. 82(1-6), and found the cases of single myoma was 44(53. 66%), and which of multiple myoma was 38(46. 34%). The average number of uterine myoma found by Myomectomy was 2. 83 (1-43), and found that the cases of multiple myoma was 44(53. 66%), which were more than that found by ultrasonography. The average diameter of the biggest myoma was 5.63cm (1. 00cm-15. 00cm). pregnancy history, the site and the size of myoma, pathology or treatment did not affect the recurrent rate. (P>0.05)
Conclusion: (1) This research finds that the recurrent rate of uterine myoma after myomectomy was 23.17%. The average time of recurrence was 32. 68 months after myomectomy. These datas are in the range with the literature. The recurrent rates of two types of Traditional Chinese Medicine of the patients underwent myomectomy were no significant differences.
(2) This research finds that the average number of uterine myoma found by ultrasonography was 1.82, and the average number of uterine myoma found by Myomectomy was 2. 83. It thinks that some patients may have some small myoma which can not find by ultrasonography.
(3) Age and the numbers of myoma is the factors which may affect the recurrent rate. The factors of less than 40 years old and multiple myoma are the risk factors of recurrence of uterine myoma after myomectomy.
(4) The factors , such as age, pregnancy history, the site and the size of myoma, pathology or treatment did not affect the recurrent rate. (P>0. 05)
方法:回顾性研究分析2000年1月至2005年12月在广州中医药大学第一附属医院妇科行子宫肌瘤切除术患者82例,回访调查复发例数及相关情况,根据中医辨证分成气滞血瘀、肾虚血瘀证两组进行比较。
结果:复发19例,复发率为23.17%。复发时间距手术平均为32.68个月(6个月-66个月)。术前B超检查发现肌瘤数平均1.82个(1个—6个),单发性44例(53.66%),多发性38例(46.34%);术中摘除肌瘤平均肌瘤数2.83个(1个—43个),术中所见为单发肌瘤38例(46.34%),多发肌瘤44例(53.66%);最大肌瘤直径平均5.63cm(1.00cm-15.00cm)。气滞血瘀证44例,复发9例(20.45%);肾虚血瘀证38例,复发10例(26.32%)。复发与术前妊娠史、家族史、临床症状、中医辨证分型、肌瘤的大小、生长部位、手术方式、病理、肌瘤是否变性、术后治疗及术后妊娠史等无明显相关性(P＞0.05),与年龄、子宫肌瘤个数有相关性。
结论:(1)本研究中82例子宫肌瘤切除术后患者复发19例,复发率为23.17%。发现复发时间距手术平均为32.68个月,符合文献报道。其中气滞血瘀证44例,复发9例,复发率为20.45%,肾虚血瘀证38例,复发10例,复发率为26.32%,两者无显著性差异。
(2)本研究中术前B超检查发现肌瘤数平均1.82个,术中摘除肌瘤平均肌瘤数2.83个,显示术中发现的肌瘤数量比术前B超发现的多,可推测部分患者存在不能被B超发现的微小肌瘤。
(3)本研究显示年龄、子宫肌瘤个数与肌瘤复发有相关性,手术年龄＜40岁和多发性子宫肌瘤者为子宫肌瘤切除术后复发的危险因素。术前B超检查发现单发性子宫肌瘤44例,复发4例,复发率为9.09%,多发性子宫肌瘤38例,复发15例,复发率39.47%,有显著性差异性(P=0.001)。术中发现为单发性子宫肌瘤38例,复发3例,复发率为7.89%;术中发现为多发性子宫肌瘤44例,复发16例,复发率36.36%,有显著性差异(P=0.002)。手术时年龄＜40岁者57例,复发17例,复发率为29.82%。年龄≥40岁者25例,复发2例,复发率为8.00%,有显著性差异(P=0.031)。
(4)子宫肌瘤切除术后复发与术前妊娠史、家族史、临床症状、中医辨证分型、肌瘤的大小、生长部位、手术方式、病理、肌瘤是否变性、术后治疗及术后妊娠史等无明显相关性(P＞0.05)
Objective: Uterine myoma is one kind of the most common benign tumor of female genital organ, which always occurs in women of childbearing age. And the morbidity increases year by year. This disease is seriously hazardous to women' health. Treating uterine myoma by Chinese medicince or Western medicine drug all gets good effects, but the treatment of medicine cannot be completely cure the uterine myoma for all. Surgery is still the main treatment for some patients who have no significant effects for medicine. As the quality of people' s life improves and the technique of minimally invasive develops, more and more patients who want to retain uterus will choose the Myomectomy. According to the litrature, recurrent rate of myomectomy is high. It thinks that people have some factors which may cause uterine myoma growth, or left small uterine myoma in surgery. This research is according to surveying the situation of the patients underwent myomectomy and the recurrent rate, analyze the risk factors of recurrence of uterine myoma after myomectomy, and find the differences of the recurrent rate and the risk factors between the two different types of Traditional Chinese Medicine of the patients underwent myomectomy.
Methqds:82 cases underwent myomectomy in the Guangzhou University of Traditional Chinese Medicine Hospital form Jan 1,2000 to Dce 31,2005 were analyzed with retrospective study. According to differentiation for syndrome classification, divide the cases into two groups (liver-qi stagnation and blood stasis, kidney deficiency and blood stasis) to compare.
Results: 19 cases were recurrent. The recurrent rate was 23.17%. The average time of recurrence was 32. 68 months after myomectomy. The average number of uterine myoma found by ultrasonography was 1. 82(1-6), and found the cases of single myoma was 44(53. 66%), and which of multiple myoma was 38(46. 34%). The average number of uterine myoma found by Myomectomy was 2. 83 (1-43), and found that the cases of multiple myoma was 44(53. 66%), which were more than that found by ultrasonography. The average diameter of the biggest myoma was 5.63cm (1. 00cm-15. 00cm). pregnancy history, the site and the size of myoma, pathology or treatment did not affect the recurrent rate. (P>0.05)
Conclusion: (1) This research finds that the recurrent rate of uterine myoma after myomectomy was 23.17%. The average time of recurrence was 32. 68 months after myomectomy. These datas are in the range with the literature. The recurrent rates of two types of Traditional Chinese Medicine of the patients underwent myomectomy were no significant differences.
(2) This research finds that the average number of uterine myoma found by ultrasonography was 1.82, and the average number of uterine myoma found by Myomectomy was 2. 83. It thinks that some patients may have some small myoma which can not find by ultrasonography.
(3) Age and the numbers of myoma is the factors which may affect the recurrent rate. The factors of less than 40 years old and multiple myoma are the risk factors of recurrence of uterine myoma after myomectomy.
(4) The factors , such as age, pregnancy history, the site and the size of myoma, pathology or treatment did not affect the recurrent rate. (P>0. 05)
引文
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