曹祖容

摘要：目的  探讨子宫黏膜下大肌瘤实施子宫动脉栓塞联合宫腔镜治疗的临床效果。方法  选择我院2017年1月～2018年7月收治的60例子宫黏膜下大肌瘤患者，随机分为宫腔镜组和联合组，各30例。宫腔镜组患者运用宫腔镜电切治疗，联合组在此基础上联合子宫动脉栓塞治疗，比较两组宫腔镜手术时间、术中出血量、术后排气时间、治疗总有效率、术后并发症情况及术后3个月血红蛋白、月经量、月经时间变化情况。结果  联合组宫腔镜手术时间、术中出血量、术后排气时间及术后并发症发生率分别为（52.23±5.67）min、（32.29±5.38）ml、（12.83±2.18）h、6.67%，均低于宫腔镜组的（72.44±6.54）min、（75.46±4.53）ml、（22.15±4.23）h、26.67%，差异有统计学意义（P<0.05）;联合组治疗总有效率为96.67%，高于宫腔镜组的80.00%，差异有统计学意义（P<0.05）;联合组术后3个月血红蛋白水平高于宫腔镜组，差异有统计学意义（P<0.05）;联合组月经量、月经时间低于宫腔镜组，差异有统计学意义（P<0.05）。结论  子宫黏膜下大肌瘤实施子宫动脉栓塞联合宫腔镜治疗效果好，且可有效减轻手术创伤，降低术后并发症风险，促进患者术后恢复。

关键词：子宫黏膜肌瘤;子宫动脉栓塞术;宫腔镜;并发癥

中图分类号：R737.33                                   文献标识码：A                              DOI：10.3969/j.issn.1006-1959.2019.18.026

文章编号：1006-1959（2019）18-0084-03

Abstract：Objective  To investigate the clinical effect of uterine artery embolization combined with hysteroscopic treatment of uterine submucosal myoma. Methods  60 patients with uterine submucosal myoma who were admitted to our hospital from January 2017 to July 2018 were randomly divided into hysteroscopic group and combined group， 30 cases for each group. Patients in the hysteroscopic group were treated with hysteroscopic electrotomy， and the combined group was combined with uterine artery embolization. The time of hysteroscopic surgery， intraoperative blood loss， and postoperative exhaust time， total effective rate of treatment and postoperative complications were compared between hemoglobin， menstrual volume and menstrual time at 3 months postoperatively. Results  The combined group hysteroscopic operation time， intraoperative blood loss， postoperative exhaust time and postoperative complication rate were （52.23±5.67） min， （32.29±5.38） ml， （12.83±2.18） h， 6.67%， respectively， were lower than （72.44±6.54） min， （75.46±4.53） ml， （22.15±4.23） h， 26.67% in the hysteroscopic group， the difference was statistically significant （P<0.05）;The total effective rate was 96.67% in the combined group， which was higher than that in the hysteroscopic group 80.00%，the difference was statistically significant （P<0.05）. The hemoglobin level in the combined group was higher than that in the hysteroscopic group at 3 months after operation，the difference was statistically significant （P<0.05）. The menstrual volume and menstrual time in the combined group were lower than those in the hysteroscopy group，the difference was statistically significant （P<0.05）.Conclusion  Uterine artery embolization combined with hysteroscopic treatment of uterine submucosal large myoma is effective， and can effectively reduce surgical trauma， reduce the risk of postoperative complications， and promote postoperative recovery.

Key words：Uterine mucosal fibroids;Uterine artery embolization;Hysteroscopy;Complications

子宫黏膜肌瘤（subumcosal  myoma of uterus）是女性最为常见的良性肿瘤病变类型，主要因子宫平滑肌细胞增生引起，常引起患者月经紊乱、子宫出血、腹痛等症状，严重时可导致女性不孕、贫血、流产，因此需及早清除子宫黏膜肌瘤，以改善女性生命安全及生活质量。目前宫腔镜技术显著进步，其在治疗子宫黏膜肌瘤中应广泛，可有效保留患者生育功能，减轻损伤。但子宫黏膜下大肌瘤患者病灶较大，实施单一宫腔镜电切难度较大，并发症风险高，也极易出现病灶残留，影响治疗效果[1]。子宫动脉栓塞是阻断子宫动脉血供的常用方法，可影响肌瘤血供，促进病灶坏死。有报道显示两者联合治疗子宫黏膜下大肌瘤效果较好，本研究选择我院收治的子宫黏膜下大肌瘤患者，比较单一宫腔镜电切治疗与联合子宫动脉栓塞的临床疗效，现报道如下。……