Surgical Treatment Of Type Ⅱ Submucous Myomas With Preservation Of Uterus

Objective:to evaluate the safety, therapeutic effects and indications of three different ways in treating type Ⅱ sub mucous myomas:hysteroscopic myomectomy and laparoscopic myomectomy as well as abdominal myomectomy.Methods:90 patients with type Ⅱ sub mucous myomas from January 2010 to December 2015 in Nanjing Drum Tower Hospital were analyzed retrospectively.30 of them received treatment of TCRM,30 received laparoscopic myomectomy and 30 received abdominal myomectomy. We analyzed pre-operative symptoms and examination, operative time and blood loss, post-operative satisfaction and myoma recurrence of different groups.Results:In hysteroscopic group, operation time and absorption of fluids are significantly different between the ≥5cm team and the other two teams(p<0.05). In laparoscopic and transabdominal group, operation time, bleeding amount, ventilation time and days in hospital are not significantly different among the three teams(p> 0.05). There are no significantly difference in the rate of symptom improvement, myoma recurrence,reoperation and full-time pregnancy among the hysteroscopic, laparoscopic and transabdominal groups. For multiple leiomyoma (type II sub mucous myomas predominantly), the transabdominal group has a lower rate of myoma recurrence compared to the other two groups.Conclusion:1、TCRM treatment of type Ⅱ sub mucous myomas is safe, feasible and minimally invasive, especially for single, smaller (D<5cm) ones. For the larger diameter type II sub mucous myomas, the risks such as uterus perforation and TURP syndromes are increased.2、Laparoscopic myomectomy should be considered when the diameters of type Ⅱsub mucous myomas are more than 5cm.3、For multiple leiomyoma (type Ⅱ sub mucous myomas predominantly), abdominal myomectomy is another choice because it is believed that abdominal myomectomy can reduce the rate of myoma recurrence.