宫腔镜电切手术治疗FIGO 3型子宫肌瘤临床分析

doi:10.3877/cma.j.issn.1674-6899.2025.06.006

目的

探讨宫腔镜子宫肌瘤切除术(transcervical resection of myoma，TCRM)治疗国际妇产科联盟(International Federation of Gynecology and Obstetrics，FIGO) 3型子宫肌瘤的可行性、安全性及临床疗效。

方法

回顾性分析2021年2月至2024年2月于空军军医大学第一附属医院(西京医院)收治的42例单发FIGO 3型子宫肌瘤患者的临床资料。记录患者围手术期情况、手术并发症、月经改善情况及术后生育结局。

结果

42例患者平均年龄34.3±5.1岁，肌瘤平均直径4.6±1.8 cm。手术一次成功率为85.7%(36/42)，平均手术时间43±18 min，平均术中出血量26±16 ml。术后瘤腔距子宫浆膜层最短距离由术前的3.1±1.3 mm显著增加至8.4±1.5 mm。所有患者均未发生子宫穿孔、大出血等严重并发症。术前月经量增多者35例，术后治愈率80.0%(28/35)，总有效率97.1%(34/35)。28例有生育需求的患者术后平均随访16.2±7.3个月，1年内妊娠率达78.5%(22/28)，已分娩17例(阴道分娩11例，剖宫产6例)，无1例子宫破裂发生。

结论

对于FIGO 3型子宫肌瘤，由经验丰富的医师在超声监护下实施宫腔镜电切术是一种安全、有效的微创治疗方式，能显著改善月经症状，并获得良好的生殖预后。

关键词: 子宫肿瘤, 平滑肌瘤, 宫腔镜子宫肌瘤去除术, 宫腔镜电切术, 生育力, FIGO 3型子宫肌瘤

Objective

To investigate the feasibility, safety, and clinical efficacy of transcervical resection of myoma (TCRM) in the management of International Federation of Gynecology and Obstetrics(FIGO) type 3 uterine fibroids.

Methods

A retrospective analysis was conducted on the clinical data of 42 patients with solitary FIGO type 3 uterine fibroids treated at XiJing Hospital, Air Force Medical University between Feb. 2021 and Feb. 2024. Perioperative parameters, surgical complications, improvement in menstrual symptoms, and postoperative reproductive outcomes were recorded and analyzed.

Results

The mean age of the 42 patients was 34.3±5.1 years, with a mean fibroid diameter of 4.6±1.8 cm. The primary procedure success rate was 85.7%(36/42). The mean operative time was 43±18 minutes, and the mean intraoperative blood loss was 26±16 ml. The shortest distance from the tumor cavity to the uterine serosa significantly increased from 3.1±1.3 mm preoperatively to 8.4±1.5 mm postoperatively. No severe complications, such as uterine perforation or major hemorrhage, occurred. Among the 35 patients with preoperative menorrhagia, the cure rate was 80.0%(28/35), resulting in a total effective rate of 97.1%(34/35). Among the 28 patients with fertility desires, the average follow-up duration was 16.2±7.3 months. The pregnancy rate within one year postoperatively was 78.5%(22/28). Seventeen patients have delivered (11 vaginal deliveries and 6 cesarean sections), with no cases of uterine rupture reported.

Conclusion

For FIGO type 3 uterine fibroids, hysteroscopic resection performed by experienced surgeons under ultrasonographic guidance is a safe and effective minimally invasive treatment. It significantly ameliorates menstrual symptoms and is associated with favorable reproductive outcomes.

Key words: Uterine neoplasms, Leiomyoma, Transcervical resection of myoma, Hysteroscopic myomectomy, Fertility preservation, FIGO type 3 uterine fibroids

图1 3型子宫肌瘤的宫腔镜术中超声监测注：A.子宫后壁肌瘤　长6.24 cm; B．子宫后壁肌瘤　宽4.95 cm；C.宫腔镜术中肌瘤切除术后，显露瘤腔

图2 宫腔镜下3型子宫肌瘤切除术中图像注：A.为宫腔后壁多发子宫内膜息肉；B.宫腔后壁去除息肉后，宫壁平整；C.宫颈注射缩宫素后，后壁3型肌瘤微突；D.宫腔镜电切3型肌瘤开窗后，肌瘤涌出(红色箭头指示肌瘤)；E、F.为宫腔镜电切3型肌瘤后显露宫腔与瘤腔(蓝色箭头指示宫腔；绿色箭头指示瘤腔)

表1 42例FIGO 3型子宫肌瘤患者的临床特征

临床特征	结果
年龄(岁，±s)	34.3±5.1
产次(次，±s)	0.5±0.2
肌瘤平均径线(cm，±s)	4.6±1.8
肌瘤位置[例(%)]
前壁	16(38)
后壁	16(38)
宫底	4 (10)
侧壁	6 (14)
手术指征^a[例(%)]
月经过多	35 (83.3)
不孕	22 (52.4)
反复流产	6 (15.3)
肌瘤距子宫浆膜层距离(mm，±s)	3.1±1.3

表1 42例FIGO 3型子宫肌瘤患者的临床特征

临床特征	结果
年龄(岁，±s)	34.3±5.1
产次(次，±s)	0.5±0.2
肌瘤平均径线(cm，±s)	4.6±1.8
肌瘤位置[例(%)]
前壁	16(38)
后壁	16(38)
宫底	4 (10)
侧壁	6 (14)
手术指征^a[例(%)]
月经过多	35 (83.3)
不孕	22 (52.4)
反复流产	6 (15.3)
肌瘤距子宫浆膜层距离(mm，±s)	3.1±1.3

图3 FIGO子宫肌瘤9型分类方法示意图^[2,17]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)

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Clinical evaluation of hysteroscopic myomectomy with electrosection for FIGO type 3 uterine fibroids

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Clinical evaluation of hysteroscopic myomectomy with electrosection for FIGO type 3 uterine fibroids