The Comparative Study Between Transcervical Resection Of Myoma And Laparoscopic Myomectomy About Intramural Uterine Myoma

Background and objectiveUterine leiomyoma is the most common benign tumor of the femalereproductiveorgan, which is composed of smooth muscle and connective tissue and itis most common in women in their30s and50s. The most common clinical symptomswere delayed menstruation, menorrhagia, vaginal fluid, compression symptoms suchas urinary frequency, urgency, stool changes, abdominal pain and infertility, but somepatients were with no obvious symptom. In recent years, with the development andapplication of transvaginal ultrasound,hysteroscopy technology, uterine fibroidsdetection rate is increasing year by year, which was deeply threatened the womanhealth and life quality.In clinical work, transvaginal ultrasound technology is an important means toassist the diagnosis of uterine fibroids, the ultrasonogram of this disease was masseswith local weakening echoes, peripheral pseudocapsule, peritumoral rich ring orsemiannular flow signal, and branched into the department of tumor, tumor bloodflowsignal in vivo was richer than uterine muscle wall. Surgery can eliminate uterinefibroids or hysterectomy and it would quickly relieve clinical symptoms by fleshtumour produces, it is the main choice of the treatment of uterine fibroids. In recent years, with the development and popularization of minimally invasive operation, byhysteroscopy,laparoscopic operation is widely used in treatment uterine leiomyomafor its small trauma, quick recovery and other advantages. Whether the treatment ofuterine fibroids and how to choose the mode of operation, how to maximize theprotection of organ function, reducing the human injury and curing the disease at thesame time, it is worth discussion.Transcervical resection of myoma(TCRM) has the advantages of shorten thepostoperative recoverytime, uterine incision less, greatly reducing the probability offuture cesareanoperation, and patients with traditional open operation comparable etc..Because of the uterine cavity operation, it is apply only to the submucosal myoma ofuterusand uterine myomectomy.Laparoscopic myomectomy(LM) is with less trauma, less bleeding, rapidrecovery, shorter hospitalization time and retain the integrity of abdominal wall，theadvantages of environmental interference pelvic small etc. Because of the intrauterinemanipulation., it is apply only to the subserous myoma of uterus and uterinemyomectomy.Thus it can be seen that because the operationmode via a pathway different forminimally invasive myomectomy operation, that the current clinical for subserousmyoma of uterus bylaparoscopic operation, submucous myoma by hysteroscopicoperation. But foruterine intramural myoma laparoscopic removal operation operationmode choice at present there is no conclusion. Through a retrospective analysis ofpatients with uterine intramural myoma laparoscopic and hysteroscopicmyomectomyoperation characteristics.ObjectiveA retrospective analysis the patients with Intramural uterine myoma treated byhysteroscopy or Laparoscop, compaire the perioperative characteristics、postoperativerecurrence、muscularis healing and pregnancy outcome.Evaluate the efficacy of twoSurgical method provide reference for clinical treatment. Materials and methods1.Materials:A retrospective analysis is carried out to explore the clinical andfollou-up data of628patients with intramural uterine myoma who were treated in theThird affiliated hospital of zhengzhou university were from January1,2007toDecember31,2011by TCRM or LM. These patients were all30-50years old, Theirfibroids’ size were all between30-60mm, the number of fibroids is3or less, and allbeen proved intramural uterine myoma by three-dimensional ultrasound,.The type offibroids were2-5type by2010FIGO uterine myoma typing. All the patiens haveinfertility with no other pelvic lesions, and excepting other factors that leading toinfertility. FIGO published a new standard of uterine typing in2010according to thelocation of uterine myoma, which divided uterine myoma into0-8types:0:pedunculated intracavitary,1:＜50%intramural,2:≥50%intramural,3: contactsendometrium;100%intramural,4: intramural,5: subserosal≥50%intramural,6:subserosal＜50%intramural,7: subserosal pedunculated,8: other (specify e.g.cervical, parasitic), mixed tumor (also involving the endometrium and uterine fibroidsserous layer): use two hyphens-connecting numerals, usually the first numberindicates the relationship of myoma and endometrial and the last number indicates therelationshio of myoma ana serous. For example:2-5: submucosal and subserosal,eachwith less than the diameter in the endometrial and peritoneal cavities,respectively. Allthe cases included in this study of myoma types are all belong to2-5. The628patients are divided into TCRM group(236cases) and LM group(392cases). Thepatients’ age of TCRM group and LM groug were respectively (30.86±3.56),(32.25±3.78)years of age, and there was no statistically significant difference (P>0.05).The patients’ eliminate fibroid number of TCRM group and LM group wererespectively (1.72±0.362),(1.3±0.830), and there was no statistically significantdifference (P>0.05). The patients’ The biggest fibroids diameter of TCRM group andLM group were respectively（38.69±11.30）、（43.75±13.39）mm, and there was nostatistically significant difference (P>0.05).To compare two groups of patients with surgery to remove fibroids biggest diameter, excluding the number of uterine fibroids,operation time, intraoperative blood loss, perioperative lower hemoglobin,postoperative fever rate, postoperative menstrual improvement, postoperativerecurrence, muscularis healing and pregnancy outcome.2.Statistical Methods: Statistical anylysis was performed using the SPSS17.0statistical software. Count data was showed by±s and anylysized by t-test.Measurement data was anylysized by Chi-square test. Non-normal distribution datawas anylysized by Fisher’s exact probability method. α=0.05acted as inspection level.Results1perioperation period indicatorThe average operation time of TCRM group and LM group were respectively（43.26±21.79）（10-125）、（87.29±25.09）（40-150）min.The average intraoperativeblood loss were respectively（12.03±9.39）（10-40）、（86.94±165.68）（10-800）ml.The reduce perioperative hemoglobin level were respectively（4.69±4.33）（-1-15）、（15.62±10.10）（-3-50）g/L,.Comparing respectively, the difference had statisticalsignificance (P <0.05). The transfer laparotomy operation rate of TCRM group andLM group were respectively0%、0.51%,。The intraoperative blood transfusion ratewere respectively0%,3.82%The postoperative fever rate were respectively3.12%,5.88%, The menstrual period after surgery were respectively96.53%,91.14%，Comparison respectively, the difference had statistical significance (P <0.05).2Postoperative recurrence rateThe effective follow-up cases of TCRM group is181patients and of LM groupis336. TCRM group and LM group patients in the postoperative follow-up time wererespectively15months (6months to24months) and18months (12monthsto24months).The recurrence rate of TCRM group was7.84%, and he recurrence rate ofLM group was10.87%. Comparison between them, there was no statisticallysignificant difference (P=0.830). Postoperative follow-up ending on July1,2013,and regular monitoring, two groups of patients with recurrence fibroids size change is not obvious.3postoperative muscle healingIn a follow-up study between181TCRM patients and336LM patients, Onemonths after operation, muscle tumor cavity completely healing rates were66.85%、0%,the difference was statistically significant (P=0.000). Three months afteroperation,muscle tumor cavity completely healing rates were88.40%,29.17%, thedifference was statistically significant (P=0.000). Six months after operation,muscletumor cavity completely healing rates were100%,66.37%, the difference wasstatistically significant (P=0.003). Twelve months after operation, muscle tumorcavitycompletely healing rates were100%,95.24%, and there wad no significantdifference (P=0.299).4postoperative pregnanciesThis study selected patients with fertility requirements for childbearing agewomen. The postoperative pregnancy rate of follow-up TCRM group and LM groupwas56.91%（103/181）、70.83%（238/336）, there was no statistically significantdifference (P=0.094).103cases of pregnancy patients with TCRM group115timespregnancy,238cases of pregnancy LM group of patients with pregnancy261times.Postoperative pregnancy from fibroids weed out of time for the first time: the averagetime for patients with TCRM group of patients with the average time was (8.55±4.154) months.,LM group (11.18±3.471) months, Both comparison, difference wasstatistically significant (P=0.015). No uterine fibroids rupture occurred in all ofpregnancy,.The patients’ abortion rates of TCRM group and LM group wererespectively0%、14.71%. Patients’ full-term pregnancy rates of TCRM grouppatients and LM group were respectively58.86%,60.47%.78patients from LMgroup had cesarean delivery due to bstetric factors, while the other22cases hadnatural childbirth.205patients from LM group had cesarean delivery due to bstetricfactors, while the other24cases had natural childbirth. To follow-up to terminate onJuly1,2013,9cases of LM group patients and3cases of TCRM group patients werein pregnancy. For cesarean section indications (macrosomia, oligohydramnios and umbilical RaoGeng) term cesarean delivery rate, there were241patients of LM group,and94cases of TCRM. Compairing was no statistically significant difference(P=1.000). As always, The cesarean delivery rates acorrding to operiong history ofTCRM group and LM group were respectively1,0. And there was no statisticallysignificant difference (P=1.902). Full-term pregnancy cesarean section averagegestational age at the time of termination of pregnancy, LM group patients were(39.54±0.13) weeks, and TCRM group patients were (39.78±0.17) weeks, therewas no statistically significant difference (P=0.570). The average of neonatal birthweight of TCRM group and LM group were (3792.78±0.17)、(3666.35±326.857)g. There was no significant difference (P=0.167).Conclusions1.For intramural myoma, two kinds of operation modes are safe and reliable.2.The muscular healing of patients traeted by TCRM is faster than the patientestraeted by LM, so hysteroscopy surgery is superior to the laparoscopic surgery.for thepatients with intramural uterine myoma.