国际妇产科学杂志

国际妇产科学杂志 ›› 2024, Vol. 51 ›› Issue (1): 66-69.doi: 10.12280/gjfckx.20230801

• 妇科肿瘤研究:论著 • 上一篇    下一篇

40~55岁子宫肌瘤患者的手术方式选择及术后生活质量

彭丽娜(), 钱林华   

  1. 310006 杭州，浙江大学医学院附属妇产科医院
  • 收稿日期:2023-10-12 出版日期:2024-02-15 发布日期:2024-02-19
  • 通讯作者: 彭丽娜 E-mail:5521031@zju.edu.cn

Selection of Surgical Methods and Quality of Life after Operation in 40-55 Years Old Patients with Uterine Fibroids

PENG Li-na(), QIAN Lin-hua   

  1. Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
  • Received:2023-10-12 Published:2024-02-15 Online:2024-02-19
  • Contact: PENG Li-na E-mail:5521031@zju.edu.cn

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摘要：

目的：分析40~55岁行子宫肌瘤剔除术或子宫切除术（包括全子宫切除术和子宫次全切除术）的子宫肌瘤患者术后生活质量，探讨预后最佳且使患者获益最大的手术方式，以制定对该人群的最佳手术方案。方法：收集2017年1—12月于浙江大学医学院附属妇产科医院行开腹或腹腔镜下子宫肌瘤剔除术或子宫切除术的744例子宫肌瘤患者的临床资料及随访资料，比较不同手术方式患者的术后生活质量改善情况。结果：按照采用的手术方式将744例患者分为肌瘤剔除组（439例）和子宫切除组（305例）。2组患者的年龄、是否绝经、是否有临床症状、肌瘤有症状年限、肌瘤数目、子宫大小、既往是否有子宫肌瘤手术史比较，差异有统计学意义（均P<0.05）。肌瘤剔除组术后有残留或复发者占69.25%。肌瘤剔除组在日间尿频、乏力感、行动能力、自我照顾、日常活动及EQ-5D-5L总分方面的改善程度均优于子宫切除组（均P<0.05）。肌瘤剔除组的性生活满意度（91.47% vs. 68.20%，Z=-7.910，P<0.001）和推荐率（82.00% vs. 53.11%，χ2=75.826，P<0.001）均高于子宫切除组。结论：行子宫肌瘤剔除术患者的术后整体生活质量高于行子宫切除术的患者。对于希望保留子宫的40~55岁患者，若年龄偏小、病程短、症状轻、子宫偏小，在告知术后高复发风险的前提下，可考虑保留子宫。

关键词: 平滑肌瘤, 子宫肌瘤切除术, 子宫切除术, 手术方式, 生活质量

Abstract:

Objective: To analyze the postoperative quality of life after myomectomy or hysterectomy (including total hysterectomy and subtotal hysterectomy) in patients with uterine fibroids aged 40 to 55 years, and to explore which surgical method can provide the best prognosis and the greatest benefit, in order to develop the best surgical program for this population. Methods: Collect clinical and follow-up data of 744 patients who underwent myomectomy or hysterectomy in the Women's Hospital, School of Medicine Zhejiang University, from January 2017 to December 2017, and compare the improvement in quality of life after operation under different surgical methods. Results: The 744 patients were divided into myomectomy group (439 cases) and hysterectomy group (305 cases). There were statistically significant differences between the two groups in age, menopause, clinical symptoms, duration of fibroid symptoms, number of fibroids, uterine size, and history of fibroid surgery (all P<0.05). In the myomectomy group, the rate of residual or recurrences was 69.25%. The myomectomy group showed greater improvement in daytime urination frequency, fatigue, mobility, self-care, usual activities, and EQ-5D-5L total quality of life score, compared to the hysterectomy group (all P<0.05). The sexual life satisfaction of the myomectomy group was higher than that of the hysterectomy group (91.47% vs. 68.20%, Z=-7.910, P<0.001), and the recommendation rate was also higher than that of the hysterectomy group (82.00% vs. 53.11%, χ2=75.826, P<0.001). Conclusions: The quality of life in the myomectomy group was higher than that in the hysterectomy group. For patients aged 40 to 55 who wish to preserve their uterus, if they are younger, have shorter conditions, have fewer symptoms, and have smaller uterus, myomectomy can be considered after informing them of the high risk of recurrence after surgery.

Key words: Leiomyoma, Uterine myomectomy, Hysterectomy, Surgical method, Quality of life