| ObjectiveThe purpose of this study was to evaluate the factors associated with the recurrence of uterine myomas, recurrence rate after myomectomy and surgical factors optimal scheme of the special aged 35 to 45 years old.Materials and Methods247 cases underwent myomectomy,aged 35 to 45 years old, from Jan 1.2000 to Dec 31,2OO4 in Guangzhou First Municipal People's Hospital Affiliated to Guangzhou Medical College, were analyzed with retrospective reviewed.The clinical symptoms, uterine size ,the location,size, number and degeneration of myomas and other aspects have been discussed. To discuss factors related with recurrence, the recurrence rate of uterine myomas after myomectomy for 5 to 10 years, patients underwent second-operation were analyzed. The results were analyzed by chi-square examination ,Wilcoxon and logistic regression analysis(Wald regressive method)with SPSS16.0 statistical software. P<0.05 was statistically significant . ResultsSingle factor analysis and logistic regression analysis showed the factors related to recurrence were age, location and number of myomas, and the time of followed up. The data showed 114 patients recurred of total 247 cases (46.2%,114/247)for 5 to 10 years. 33 recurred patients underwent second-operation. (13.4%,33/247,26 total hysterectomy and 7 myomectomy).1. The recurrence rate of patients aged 35 to 39 years old and aged 40 to 45 years old were 39.7% and 54.1% respectively,the difference was statistically significant (P<0.05).2. The recurrence rates of myoma number less than 2 and was or more than 2 were 23.1% and 66.9% respectively,the result was significantly different (P<0.05).3. The recurrence rates of the largest myoma diameter less than 5cm, was 5cm or more than were 44.6% and 46.8% respectively, the recurrence rates between the two groups showed no significant difference(P>0.05).4. Submucous myoma,intramural myoma and subserous myoma recurrence rates were 15.4%,37.7% and 25.0%,significantly lower than multiple myomas recurrence rate was 67.4%,the difference was statistically significant(P<0.05). But the recurrence rates among submucous myoma,intramural myoma and subserous myoma showed no significant difference(P>0.05).5. Transvaginal myomectomy, Transabdominal myomectomy and Laparoscopic myomectomy recurrence rates were 36.4%,49.7% and 41.8%, But the recurrence rates among the three groups showed no significant difference(P>0.05).6. The recurrence rates of the cases with or without cellular were 60.0% and 45.6% respectively, the recurrence rates between the two groups showed no significant difference(P>0.05). the recurrence rates of the cases with or without other Benign degeneration were 46.9% and 39.1% respectively,but the recurrence rates between the two groups showed no significant difference(P>0.05).7. The recurrence rate lower in patients with uterine size less than 10 menstrual weeks (43.6%), compared with 10 menstrual weeks or more (52.0%), but the result showed no significant difference(P>0.05) 8. The times of pregnancy less than 2 recurrence rate was 38.7% , lower than times of pregnancy was or more than 2 recurrence rates was 49.4%, But the recurrence rates between the two groups showed no significant difference(P>0.05).9. The patients with childbirth history recurrence rate was 47.9%,higher than The patients without childbirth history,the latter was 33.3%,but But the recurrence rates between the two groups showed no significant difference(P>0.05).10. The cases with or without gynecological diseases recurrence rates were 50.0% and 42.9% respectively, the recurrence rates between the two groups showed no significant difference(P>0.05).11. the recurrence rate of the cases with clinical symptoms was 44.9% ,and the recurrence rate of the cases without clinical symptoms was 48.4%,but the recurrence rates between the two groups showed no significant difference(P>0.05).12. the patients who were followed up less than 5 years, The cumulative probability of recurrence increased steadily during the follow-up period, 13.0% in 1 year, 29.1% in 3 years, and reached 41.7% in 5 years. the difference was statistically significant(P<0.05). the cumulative probability of recurrence was 46.2% in 10 years,But cumulative probability of recurrence of patients who were followed up 5 years or 10 years showed no significant difference(P>0.05).13. The data showed 21 infertile women of total 247 cases,9 cases were pregnant after myomectomy,the pregnancy rate was 42.9%.5 parturients performed cesarean section,missed abortion in 1 case,1 case of ectopic pregnancy,2 patients undergoing artifical abortion operation .14. The data showed 91(36.8%) patients of total 247 cases who without clinical symptoms were found myoma by physical examination. 156(63.2%) patients of total 247 cases with clinical symptoms. Conclusion1. the factors related to recurrence were age,number, location of myomas,and the time of followed up.Other clinical features and the characteristics of cases,such as the diameter of the largest myoma,surgical approach for myomectomy, Postoperative pathology, uterine size, pregnant times, childbirth history, gynecological diseases and clinical symptoms did not affect the recurrence rate .2. the recurrence rate of uterine myoma after myomectomy is high(46.2%), the cumulative probability of reoperation for recurrent leiomyoma was much lower 13.4% in the group aged 35 to 45 years old.So the patients who needed operation in this special age group were suggested myomectomy.3. The pregnant rate after myomectomy of the patients who found myoma is the only affected reason to pregnancy can be improved.4. There are a good many patients(36.8%) without clinical symptoms were found myoma by physical examination, the physical examination which is very important for the woman at childbearing age,is the effective method to discover uterine myoma early. |
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