子宫肌瘤剥除术后复发相关危险因素分析

摘要

目的 探讨子宫肌瘤剥除术后复发的相关危险因素.方法 选取473例子宫肌瘤剥除术患者,经统一调查间卷表收集子宫肌瘤相关特点、手术方式、组织病理类型及术后肌瘤复发情况等临床资料,采用病例-对照研究的方法,进行相关因素的相关性分析及多因素条件Logistic回归分析,计算各相关危险因素与子宫肌瘤剥除术后复发的关联程度OR值及其95％可信区间(95％ CI).结果 术后随访2～7年,其中共有194例患者子宫肌瘤剥除术后复发.术中子宫肌瘤数目是子宫肌瘤剥除术后复发的高危因素,肌瘤数目多发者(≥2个)较单发者(1个)术后肌瘤复发的风险大(OR =2.31,95％ CI:1.57～3.40,P=0.ooo);其次术前产次是子宫肌瘤剥除术后复发的保护因素,术前产次越多,子宫肌瘤术后复发的风险越低(OR =0.63,95％ CI:0.48～0.84,P=0.002);而手术时年龄、手术方式、组织病理类型与子宫肌瘤剥除术后复发的风险无明显相关性.结论 术中肌瘤数目是子宫肌瘤剥除术后复发的高危因素,术前产次是子宫肌瘤剥除术后复发的保护因素,而经腹腔镜子宫肌瘤剥除术、富于细胞型平滑肌瘤及肌壁间子宫肌瘤并不增加子宫肌瘤剥除术后复发的风险.%Objective To explore the risk factors related to postoperative recurrence of uterine fibroid following myomectomy.Methods Four hundred and seventy-three uterine fibroid patients underwent myomectomy were recruited in the case-control study.Leiomyoma characteristics,surgical approach,pathological type and follow-up information were collected by questionnaire.Data were analyzed by correlation analysis and multivariate conditional logistic regression analysis.The calculation of the risk factors associated with the degree of the recurrence after myomectomy was OR and its 95％ confidence interval (95％ CI).Results Among patients,194 cases with recurrence were detected after the 2-7 years follow-up.The number of fibroid removed was the risk factor of postoperative recurrence (OR =2.31,95％ CI:1.57-3.40,P =0.000).Compared with the single fibroid,the risk of recurrence increased 2.31 times in those patients who removed more than two fibroids.Preoperative parity was the protective factor for recurrence (OR =0.63,95％ CI:0.48-0.84,P =0.002).Neither age nor surgical approach or pathological type was associated with the risk of postoperative recurrence related to uterine fibroid following myomectomy.Conlcusion Fibroid number was the risk factor of postoperative recurrence while the preoperative parity was the protective factor.Laparoscopic myomectomy,cellular leiomyoma and muscle intramural leiomyoma did not increase the risk of recurrence.