Analysis Of Risk Factors Associated With Residue And Recurrence After Myomectomy

Objective: To investigate the risk factors associated with residue and recurrence of fibroids after myomectomy,and to reduce the recurrence rate of postoperative uterine fibroids.Methods: A total of 280 patients who underwent myomectomy from January 2016 to January 2018 were enrolled,including 162 patients from the same group in the Department of Obstetrics and Gynecology in the Affiliated Hospital of Qingdao University and 118 patients in Wendeng District People's Hospital were analyzed with retrospective cohort study.The relevant clinical data of the patient were recorded,including age,age of menarche,height,weight,preoperative ultrasound evaluation of fibroids,surgical procedure,intraoperative findings of fibroid size,type,number,ultrasound monitoring,and pathological types.Meanwhile,Real-time quantitative polymerase chain reaction(RT-PCR)was used to detect the expression levels of miR-29 c,miR-200 c,miR-93 and miR-21 in surgically removed uterine fibroids and normal myometrium.The patients' follow-up after surgery was recorded,including uterine incision scar repair,residue and recurrence of fibroids,pregnancy status of patients with fertility requirements.For those patients with recurrence of uterine fibroids,the number and size of recurrent uterine fibroids,whether to operate again and the time of secondary myomectomy were recorded.ANOVA and multivariate analyses were performed on factors that may be associated with residue and recurrence of fibroids.Results: Among 280 patients who underwent myomectomy,33 patients had residual fibroids,and the residual rate was 11.79%.Among them,the residual rates of surgical fibroids in patients with single fibroid and multiple uterine fibroids were 2.56%(2/78)and15.35%(31/202),respectively.The residual rate of multiple uterine fibroids was significantly higher than that of single fibroids(p < 0.05).Postoperative fibroid residual rates were 25.42%(15/59),8.47%(5/59)and 8.02%(13/162)in the laparoscopic group,the laparotomy group and the laparoscopic ultrasonography during surgery group,respectively.The residual rate of laparoscopic ultrasonography during surgery group and laparotomy group was significantly lower than that of laparoscopy group(p < 0.05).Factors such as the age of menarche and operation,BMI,size of fibroids,and pathological type were notstatistically significant with the residual rate of uterine fibroids(p > 0.05).The number of uterine fibroids(RR=6.599,95%CI 1.685-25.847,p =0.007),surgical method(RR=0.327,95%CI 0.109-0.980,p =0.046),and intraoperative ultrasound monitoring(RR=2.023,95%CI0.695-5.886,p =0.196)were the main risk factors influencing the residual hysteromyomectomy.Compared with the normal myometrium,the expression levels of miR-29 c,miR-200 c and miR-93 in uterine fibroids were significantly decreased,and the expression level of miR-21 was significantly increased.280 patients were followed up for 1 to 3 years after surgery.The average time of follow-up was 2.04±0.26 years.Recurrence was found in 88 cases,and the cumulative rate of recurrence was 31.43%.Among them,the recurrence rates of surgical fibroids in patients with single fibroids and patients with multiple uterine fibroids were 19.23%(15/78)and36.13%(73/202).The recurrent rate of fibroids with 2 or more fibroids was significantly higher than that of single fibroids(p < 0.05).Postoperative fibroid recurrence rates were52.54%(31/59),27.12%(16/59)and 25.31%(41/162)in the laparoscopic group,the laparotomy group and the laparoscopic ultrasonography during surgery group,respectively.The recurrence rate of laparotomy group was lower than that of laparoscopic surgery without ultrasound group(p < 0.05).The recurrence rate of patients who underwent laparoscopic ultrasonography during surgery was significantly lower than that of non-ultrasound monitor(p < 0.05).No significant statistical significance was found in the recurrence rate between the laparotomy group and the laparoscopic ultrasound monitoring group(p > 0.05).There was no statistically significant difference between the age of menarche and operation,BMI,size of fibroids,postoperative special pathological type,postoperative pregnancy and postoperative recurrence of uterine fibroids(p > 0.05).Multivariate analysis showed that the number of uterine fibroids,surgical methods and intraoperative ultrasound monitoring were the main risk factors for recurrence after myomectomy.Compared with patients with non-recurrent uterine fibroids,the expression of miR-21 was significantly increased in patients with relapsed fibroids(p<0.05);the low expression of miR-29 c and recurrent uterine fibroids were significant(p<0.05).Conclusion: The number of uterine fibroids,surgical methods,and intraoperative ultrasound monitoring are the main risk factors for recurrence after myomectomy.For patients who need myomectomy,adequate preoperative assessment should be made,appropriate surgical path should be selected,and postoperative recurrence and reoperation risk should be informed.Intraoperative ultrasound monitoring is an effective method to improve the residual fibroids in hysteromyomectomy,which can make up for the bottleneckof untouchable operation in laparoscopic surgery.Postoperative detection of miR-29 c and miR-21 expression in patients with myoma tissue can be used as a potential biomarker for predicting recurrence of fibroids after uterine fibroid surgery.