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中华腔镜外科杂志(电子版) ›› 2024, Vol. 17 ›› Issue (04) : 199 -204. doi: 10.3877/cma.j.issn.1674-6899.2024.04.002

指南与共识

《宫腔镜下子宫肌瘤去除术管理规范》团体标准的解读
魏莉1, 张浩2, 谭欣3, 邓姗4, 黄秀峰5, 冯力民6,()   
  1. 1. 710032 陕西,空军军医大学第一附属医院
    2. 510180 广东,广州市第一人民医院
    3. 610066 四川,四川大学华西第二医院
    4. 100730 北京,中国医学科学院北京协和医院
    5. 310006 杭州,浙江大学医学院附属妇产科医院
    6. 100070 北京,首都医科大学附属北京天坛医院
  • 收稿日期:2024-07-17 出版日期:2024-08-30
  • 通信作者: 冯力民

Interpretation of the association standard for the management of hysteroscopic myomectomy

Li Wei1, Hao Zhang2, Xin Tan3, Shan Deng4, Xiufeng Huang5, Limin Feng6,()   

  1. 1. XiJing Hospital, Air Force Medical University, Shaanxi 710032, China
    2. The First People′s Hospital of Guangzhou city, Guangdong 510180, China
    3. West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
    4. Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing 100730, China
    5. Women′s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310006, China
    6. Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
  • Received:2024-07-17 Published:2024-08-30
  • Corresponding author: Limin Feng
引用本文:

魏莉, 张浩, 谭欣, 邓姗, 黄秀峰, 冯力民. 《宫腔镜下子宫肌瘤去除术管理规范》团体标准的解读[J]. 中华腔镜外科杂志(电子版), 2024, 17(04): 199-204.

Li Wei, Hao Zhang, Xin Tan, Shan Deng, Xiufeng Huang, Limin Feng. Interpretation of the association standard for the management of hysteroscopic myomectomy[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2024, 17(04): 199-204.

宫腔镜手术是黏膜下肌瘤微创保守性的一线治疗方案,随着宫腔镜技术的推广普及、作为一种普遍开展的常见病手术类型,中国妇幼保健协会于2023年10月22日颁布了《宫腔镜下子宫肌瘤去除术管理规范》(T/CMCHA 002-2023)团体标准。旨在为宫腔镜下子宫肌瘤去除术的技术、管理、实施方面提供指导和支持。该标准对宫腔镜下子宫肌瘤去除术的医疗机构、团队人员、设备和环境提出了标准化要求。同时,该标准还规范了宫腔镜下子宫肌瘤去除术的临床技术标准,包括手术技术、培训制度、结果评价和质量控制管理等。本文对该团体标准中提出的要求与建议进行解读,以期为临床工作者更好地理解及应用标准、规范临床实践提供参考。

Hysteroscopic myomectomy (HM) is the first-line minimally invasive and conservative surgical treatment for submucosal leiomyomas, With the popularization of hysteroscopy technology, as a common surgical method for uterine fibroids, On October 22, 2023, the Chinese Maternal and Child Health Association issued the association standard "Management of hysteroscopic myomectomy" (T/CMCHA 002-2023), which providing guidance and support for the technique, management and implementation of hysteroscopic myomectomy. The standard puts forward standardized requirements for medical institutions, team personnel, equipment and environment of hysteroscopic myomectomy. Meanwhile, the standard also standardized the clinical technical standards for hysteroscopic myomectomy, including surgical techniques, training systems, results evaluation and quality control management. This article interprets the requirements and recommendations outlined in the standard, aiming to assist clinical workers in comprehending and implementing the standard in clinical practice in a standardized manner.

图1 FIGO子宫肌瘤9型分类方法示意图注:0∶0型(有蒂黏膜下肌瘤) 1:1型(无蒂黏膜下肌瘤,向肌层扩展≤50%) 2:2型(无蒂黏膜下肌瘤,向肌层扩展>50%) 3:3型(肌壁间肌瘤,位置靠近宫腔,瘤体外缘距子宫浆膜层≥5 mm) 4:4型(肌壁间肌瘤,位置靠近子宫浆膜层,瘤体外缘距子宫浆膜层<5 mm)5:5型(肌瘤贯穿全部子宫肌层) 6:6型(肌瘤突向浆膜) 7:7型(肌瘤完全位于浆膜下,有蒂) 8:8型(其他特殊类型或部位的肌瘤,子宫颈肌瘤)
表1 STEPW术前评分
1
Loddo A, Djokovic D, Drizi A, et al. Hysteroscopic myomectomy: the guidelines of the International Society for Gynecologic Endoscopy (ISGE)[J]. Eur J Obstet Gynecol Reprod Biol, 2022, 268:121-128.
2
杨欣.出血性疾病所致异常子宫出血诊治专家共识[J]. 中国妇产科临床杂志2022, 23(6):668-672.
3
American Association of Gynecologic Laparoscopists (AAGL): Advancing Minimally Invasive Gynecology Worldwide. AAGL practice report: practice guidelines for the diagnosis and management of submucous leiomyomas[J]. J Minim Invasive Gynecol, 2012, 19(2):152-171.
4
Laganà AS, Alonso Pacheco L, Tinelli A, et al. Management of asymptomatic submucous myomas in women of reproductive age: a consensus statement from the Global Congress on Hysteroscopy Scientific Committee[J]. J Minim Invasive Gynecol, 2019, 26(3):381-383.
5
Pérez-López FR, Ornat L, Ceausu I, et al. EMAS position statement: management of uterine fibroids[J]. Maturitas, 2014, 79(1):106-116.
6
Practice Committee of the American Society for Reproductive Medicine. Practice Committee of the American Society for Reproductive Medicine. Removal of myomas in asymptomatic patients to improve fertility and/or reduce miscarriage rate: a guideline[J]. Fertil Steril, 2017, 108(3):416-425.
7
Turner BM, Cramer SF, Heller DS. The pathogenesis of abnormal uterine bleeding in myopathic uteri[J]. Ann Diagn Pathol, 2021, 52:151726.
8
Vitale SG, Riemma G, Ciebiera M, et al Hysteroscopic treatment of submucosal fibroids in perimenopausal women: when, why, and how?[J]. Climacteric, 2020, 23(4):355-359.
9
Han Y, Yao R, Zhang Y, et al. Hysteroscopic resection of type 3 fibroids could improve the pregnancy outcomes in infertile women: a case-control study[J]. BMC Pregnancy Childbirth, 2022, 22(1):522.
10
徐大宝,冯力民主编. 宫腔镜手术技巧及并发症防治[M]. 北京:人民卫生出版社,2019.
11
冯力民主译. 宫腔镜下的世界:从解剖到病理[M]. 北京:中国协和医科大学出版社出版,2018.
12
Lasmar RB, Barrozo PR, Dias R, et al. Submucous myomas: a new presurgical classification to evaluate the viability of hysteroscopic surgical treatment--preliminary report[J]. J Minim Invasive Gynecol, 2005, 12(4):308-311.
13
黄晓武,夏恩兰,黄睿,等. 宫腔镜下子宫肌瘤切除术保留假包膜与否对子宫创面愈合的影响[J]. 国际妇产科学杂志2018, 45(01):89-93.
14
Wu WJ, Goldberg LH, Rubenzik MK, et al. Review of the evaluation and treatment of vasovagal reactions in outpatient procedures[J]. Dermatol Surg, 2018, 44(12):1483-1488.
15
Brooks PG. Venous air embolism during operative hysteroscopy[J]. J Am Assoc Gynecol Laparosc, 1997, 4(3):399-402.
16
Ruiz de Santaquiteria Torres V, Palomo López R, Rubio Arroyo M, et al. Carbon monoxide poisoning and air embolism following hysteroscopic myomectomy: a case report[J]. J Gynecol Obstet Hum Reprod, 2022, 51(8):102431.
17
Vilos GA, Hutson JR, Singh IS, et al. Venous gas embolism during hysteroscopic endometrial ablation: report of 5 cases and review of the literature[J]. J Minim Invasive Gynecol, 2020, 27(3):748-754.
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