【摘要】 目的：应用宫腔镜手术治疗子宫肌瘤，并研究其预后与肌瘤切除程度的关系。方法：１９９０年５月～１９９４年１２月因子宫肌瘤导致异常子宫出血而行经宫颈子宫肌瘤切除术（ＴＣＲＭ）和（或）经宫颈子宫内膜切除术（ＴＣＲＥ）１７７例，失访１９例，随访１５８例，平均随访时间２９．３月（５个月至５年）。根据经宫颈切除肌瘤多少将１５８例手术方法分为４类；根据术后随访结果，包括出血控制程度、残余肌瘤生长速度、是否再次手术，分为完全满意、满意和不满意。结果：应用宫腔镜手术治疗子宫肌瘤，术后完全满意率达９４．９％（１５０／１５８），远远高于子宫肌瘤剔除术。粘膜下肌瘤完全切除治愈率可达１００．０％，宽蒂粘膜下肌瘤及壁间肌瘤只要切除≥５０％或单纯内膜切除后，虽残留小的壁间肌瘤及浆膜下肌瘤均可获得满意疗效，且所剩肌瘤经远期随访多数不再生长。结论：治疗因子宫肌瘤引起的异常子宫出血，经宫颈电切术是一种有效的手段。术前对手术切除肌瘤多少的正确估计，有助于对手术预后的准确判断，提高手术治愈率。更多还原

【Abstract】 Objective: To treat hysteromyoma by hysteroscopic surgery and to examine the treatment results in relation to the extent of surgery. Methods: 177 patients admitted from May, 1990 to Dec. 1994 for abnormal uterine bleeding caused by hysteromyoma were subjected to transcervical resection of myoma (TCRM) and/or transcervical resection of endometrium (TCRE). Except for 19 patients lost to follow up, 158 patients were closely observed postoperatively. The mean follow up was 29.3 months (range 5￣60). These patients were divided into four groups according to the extent of the resected myoma. Analysis was based on 3 categories: the degree of bleeding control, the rate of growth of myoma and the need of subsequent surgery, and the treatment results were grouped into: perfection, satisfaction and dissatisfaction. Results: The growth of myoma and bleeding were controlled in 150 patients (94.9%) after resection. The result was much better than that of abdominal myomectomy. The treatment success of total resection of pediculate submucosal myoma was as high as 100%. If only ≥50% of sessile submucosal myoma and intramural myoma were resected, the results of hysteroscopic surgery were satisfactory although there might be small residual intramural myoma or subserous myoma. Long term follow up showed the residual myomata seemed to have stopped growing. Conclusion: Trans cervical resection is one of the effective treatments for abnormal uterine bleeding in hysteromyoma. Preoperative accuracy in appraisal of the extent of the myoma to be resected may help to correctly predict the prognosis and to improve the surgical cure rate.更多还原