作者单位：518112 深圳，深圳市龙岗区第二人民医院妇产科(旷文佳，董晨)；510700 广州，中山大学附属第一医院东院(陈爱月，刘俊)

    子宫肌瘤剔除术后残留及复发危险因素分析

    旷文佳陈爱月董晨刘俊

    【摘要】目的探讨子宫肌瘤剔除术后肌瘤残留及复发的相关危险因素。方法收集同期行腹腔镜或开腹子宫肌瘤剔除术并定期随诊408例患者的临床资料，记录其一般情况、肌瘤特征、手术方式、术后残留及复发情况，采用logistic 回归分析术后肌瘤残留危险因素，采用Cox回归模型分析术后复发危险因素。结果腹腔镜与开腹子宫肌瘤剔除术的术后残留率、累积复发率比较差异均无统计学 (P均>0.05)。肌瘤数目是子宫肌瘤剔除术后残留(OR=1.215，95%CI：1.145～1.278，P=0.023)及复发(RR=1.189，95%CI：1.065～1.246，P=0.034)的危险因素；肌瘤类型(肌壁间肌瘤)是术后复发危险因素(RR=4.654，95%CI: 3.865～5.984，P=0.026)；年龄(年龄≥35岁)是术后复发危险因素(RR=2.976，95%CI：2.213～4.509，P= 0.013)。结论腹腔镜和开腹子宫肌瘤剔除术均是保留子宫的安全、有效的治疗方式，腹腔镜并不增加肌瘤剔除术后的残留及复发危险，肌瘤数目≥4个是子宫肌瘤剔除术后残留的主要危险因素，肌瘤数目≥4个、肌壁间肌癌、患者年龄≥35岁是子宫肌瘤剔除术后复发的主要危险因素。

    【关键词】子宫肌瘤；肌瘤剔除术；残留；复发

    DOI：10.3969/g.issn.0253-9802.2015.05.010

    通讯作者，旷文佳，E-mail:1460466013@qq.com

    收稿日期：(2015-01-18)

    Analysis of the risk factors for postoperative residue and recurrence in patients with leiomyomaKuangWenjia，ChenAiyue，DongChen，LiuJun.DepartmentofGynaecologyandObstetrics,theSecondPeople’sHospitalofLonggang,Shenzhen518112,China

    Correspondingauthor,KuangWenjia，E-mail:1460466013@qq.com

    Abstract【s】ObjectiveTo discuss the risk factors for postoperative residue and recurrence in patients with leiomyoma. MethodsClinical data including demographic information, leiomyoma characteristics, surgical approach, postoperative residue and recurrence were recorded from 408 women undergoing laparoscopic (LM) or transabdominal myomectomy (TAM) and regular follow-up. The risk factors for postoperative residue of leiomyoma were assessed by logistic regression analysis, and those for postoperative recurrence were evaluated by Cox regression analysis. ResultsThere were no statistical differences in rates of postoperative residual and cumulative recurrence between LM and TAM (P>0.05).The number of leiomyoma was a risk factor for postoperative residue and recurrence of leiomyoma. The rate of postoperative residue was increased by 0.215 times (OR=1.215, 95%CI: 1.145～1.278, P=0.023) and that of postoperative recurrence was elevated by 0.189 times (OR=1.189, 95%CI:1.065～1.246, P=0.034) when the number of leiomyoma was increased by one. The type of leiomyoma (intramural leiomyoma) (RR=4.654,95%CI:3.865～5.984, P=0.026) and age (≥35 years) (RR=2.976,95%CI:2.213～4.509, P=0.013) were risk factors for postoperative recurrence of leiomyoma. ConclusionsBoth LM and TAM are safe and effective surgical approaches for retaining the uterus of patients with leiomyoma. LM would not increase the rates of postoperative residue or recurrence. The number of leiomyoma is the main risk factor for postoperative residue. The number and type of leiomyoma and patients’ age serve as major risk factors for postoperative recurrence. ......