目的：探究育龄期子宫肌瘤异常肥大和子宫肌瘤剔除术后残留的高危因素，以期为临床上育龄期子宫肌瘤患者的治疗提供思路和理论依据。方法：收集331例育龄期患者，根据是否发生子宫肌瘤的异常肥大，将患者分成异常肥大组和非异常肥大组，其中异常肥大组患者54例，非异常肥大组患者277例。其中54例育龄期子宫肌瘤异常肥大患者选择子宫肌瘤剔除术。54例子宫肌瘤异常肥大的子宫肌瘤患者均选择子宫肌瘤剔除术，根据是否有残留分成残留组和非残留组，收集入组者的基准资料，包括年龄，体重指数，病理类型。利用Logistic回归分析进行单因素和多因素分析。结果：入组的331例育龄期患者中，有54例子宫肌瘤患者出现育龄期异常肥大，育龄期后子宫肌瘤异常肥大率为16.31%。单因素分析结果显示，超重，子宫肌瘤数目 ≥ 5个，最大肌瘤直径，富于细胞型子宫肌瘤是育龄期子宫肌瘤异常肥大的高危因素(P < 0.05)。Logistic多因素分析结果显示，超重，子宫肌瘤数目 ≥ 5，病理类型是育龄期子宫肌瘤异常肥大的高危因素(P < 0.05)。54例子宫肌瘤异常肥大患者选择子宫肌瘤剔除术，有18例子宫肌瘤患者出现术后残留，肌瘤术后残留率为33.33%。单因素分析结果显示，超重，子宫肌瘤数目 ≥ 5个，最大肌瘤直径，富于细胞型子宫肌瘤是育龄期子宫肌瘤手术剔除术后残留的高危因素(P < 0.05)。Logistic多因素分析结果显示，超重，子宫肌瘤数目 ≥ 5，病理类型是育龄期子宫肌瘤手术剔除术后残留的高危因素(P < 0.05)。结论：超重，子宫肌瘤数目 ≥ 5个，最大肌瘤直径，富于细胞型子宫肌瘤是育龄期子宫肌瘤异常肥大和子宫肌瘤手术剔除术后残留的高危因素。 Objective: To explore the high-risk factors of excessive hypertrophy of hysteromyomas and residual hysteromyoma, in order to provide ideas and theoretical basis for the clinical treatment of hysteromyoma patients in child-bearing period. Methods: The 331 patients in child-bearing period were collected. According to the growth of uterine fibroids, the patients were divided into excessive hypertrophy and non-excessive hypertrophy, including 54 patients in excessive hypertrophy and 277 patients in non-excessive hypertrophy. Among them, 54 patients with hysteromyoma excessive hypertrophy, and hysteromyomectomy was selected. All 54 patients with uterine fibroids with continuous growth of uterine fibroids were selected for myomectomy. They were divided into the residual group and the non-residual group according to whether there was residual. The baseline data of the participants were collected, including age, the body mass index (BMI), pathological type. The Logistic regression analysis was used for univariate and multivariate analysis. Results: Among the 331 patients in child-bearing period in the group, 54 patients with hysteromyoma excessive hypertrophy, and the excessive hypertrophy rate of hysteromyoma was 16.31%. The univariate analysis showed that overweight, the number of hysteromyoma ≥ 5, the maximum diameter of hysteromyomas, cell-rich hysteromyomas were the high-risk factors for the excessive hypertrophy of hyster-omyomas in child-bearing period (P < 0.05). The results of logistic multivariate analysis showed that overweight, the number of hysteromyomas ≥ 5, pathological type were the high-risk factors for the excessive hypertrophy of hysteromyomas (P < 0.05). The myomectomy was selected in 54 patients with excessive hypertrophy of hysteromyoma. 18 patients with hysteromyoma had postoperative residue, and the residual rate of hysteromyoma was 33.33%. The univariate analysis showed that overweight, the number of hysteromyomas ≥ 5, the maximum diameter of hystero-myomas, cell-rich hysteromyomas were the high-risk factors for residual after surgical removal of hysteromyomas in child-bearing period (P < 0.05). The results of logistic multivariate analysis showed that overweight, the number of hysteromyomas ≥ 5, pathological type were the high-risk factors of residual after surgical removal of hysteromyomas in child-bearing period (P < 0.05). Con-clusion: The overweight, the number of hysteromyomas ≥ 5, the maximum diameter of hysteromyomas, cell-rich hysteromyomas are the high-risk factors for the continued growth of hysteromyomas and the residue after surgical removal of hysteromyomas.
目的：探究育龄期子宫肌瘤异常肥大和子宫肌瘤剔除术后残留的高危因素，以期为临床上育龄期子宫肌瘤患者的治疗提供思路和理论依据。方法：收集331例育龄期患者，根据是否发生子宫肌瘤的异常肥大，将患者分成异常肥大组和非异常肥大组，其中异常肥大组患者54例，非异常肥大组患者277例。其中54例育龄期子宫肌瘤异常肥大患者选择子宫肌瘤剔除术。54例子宫肌瘤异常肥大的子宫肌瘤患者均选择子宫肌瘤剔除术，根据是否有残留分成残留组和非残留组，收集入组者的基准资料，包括年龄，体重指数，病理类型。利用Logistic回归分析进行单因素和多因素分析。结果：入组的331例育龄期患者中，有54例子宫肌瘤患者出现育龄期异常肥大，育龄期后子宫肌瘤异常肥大率为16.31%。单因素分析结果显示，超重，子宫肌瘤数目 ≥ 5个，最大肌瘤直径，富于细胞型子宫肌瘤是育龄期子宫肌瘤异常肥大的高危因素(P < 0.05)。Logistic多因素分析结果显示，超重，子宫肌瘤数目 ≥ 5，病理类型是育龄期子宫肌瘤异常肥大的高危因素(P < 0.05)。54例子宫肌瘤异常肥大患者选择子宫肌瘤剔除术，有18例子宫肌瘤患者出现术后残留，肌瘤术后残留率为33.33%。单因素分析结果显示，超重，子宫肌瘤数目 ≥ 5个，最大肌瘤直径，富于细胞型子宫肌瘤是育龄期子宫肌瘤手术剔除术后残留的高危因素(P < 0.05)。Logistic多因素分析结果显示，超重，子宫肌瘤数目 ≥ 5，病理类型是育龄期子宫肌瘤手术剔除术后残留的高危因素(P < 0.05)。结论：超重，子宫肌瘤数目 ≥ 5个，最大肌瘤直径，富于细胞型子宫肌瘤是育龄期子宫肌瘤异常肥大和子宫肌瘤手术剔除术后残留的高危因素。
育龄期，子宫肌瘤，残留，继续增长
Cuihua Lu
Department of Obstetrics and Gynecology, Shan County Central Hospital, Heze Shandong
Received: Jun. 8th, 2022; accepted: Jul. 18th, 2022; published: Jul. 25th, 2022
Objective: To explore the high-risk factors of excessive hypertrophy of hysteromyomas and residual hysteromyoma, in order to provide ideas and theoretical basis for the clinical treatment of hysteromyoma patients in child-bearing period. Methods: The 331 patients in child-bearing period were collected. According to the growth of uterine fibroids, the patients were divided into excessive hypertrophy and non-excessive hypertrophy, including 54 patients in excessive hypertrophy and 277 patients in non-excessive hypertrophy. Among them, 54 patients with hysteromyoma excessive hypertrophy, and hysteromyomectomy was selected. All 54 patients with uterine fibroids with continuous growth of uterine fibroids were selected for myomectomy. They were divided into the residual group and the non-residual group according to whether there was residual. The baseline data of the participants were collected, including age, the body mass index (BMI), pathological type. The Logistic regression analysis was used for univariate and multivariate analysis. Results: Among the 331 patients in child-bearing period in the group, 54 patients with hysteromyoma excessive hypertrophy, and the excessive hypertrophy rate of hysteromyoma was 16.31%. The univariate analysis showed that overweight, the number of hysteromyoma ≥ 5, the maximum diameter of hysteromyomas, cell-rich hysteromyomas were the high-risk factors for the excessive hypertrophy of hysteromyomas in child-bearing period (P < 0.05). The results of logistic multivariate analysis showed that overweight, the number of hysteromyomas ≥ 5, pathological type were the high-risk factors for the excessive hypertrophy of hysteromyomas (P < 0.05). The myomectomy was selected in 54 patients with excessive hypertrophy of hysteromyoma. 18 patients with hysteromyoma had postoperative residue, and the residual rate of hysteromyoma was 33.33%. The univariate analysis showed that overweight, the number of hysteromyomas ≥ 5, the maximum diameter of hysteromyomas, cell-rich hysteromyomas were the high-risk factors for residual after surgical removal of hysteromyomas in child-bearing period (P < 0.05). The results of logistic multivariate analysis showed that overweight, the number of hysteromyomas ≥ 5, pathological type were the high-risk factors of residual after surgical removal of hysteromyomas in child-bearing period (P < 0.05). Conclusion: The overweight, the number of hysteromyomas ≥ 5, the maximum diameter of hysteromyomas, cell-rich hysteromyomas are the high-risk factors for the continued growth of hysteromyomas and the residue after surgical removal of hysteromyomas.
Keywords:Child-Bearing Period, Fibroid, Residual, Recrudescence
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子宫肌瘤是妇产科常见的一种良性肿瘤性疾病，其病理特点是平滑肌细胞增生和细胞外基质(Extracellular Matrix, ECM)过度沉积 [
本研究选择自2018年1月至2020年1月收入我院妇科的331例育龄期患者，根据是否发生子宫肌瘤的异常增长，将患者分成异常肥大组和非异常肥大组，其中异常肥大组患者54例，非异常肥大组患者277例。其中54例育龄期子宫肌瘤异常肥大患者选择子宫肌瘤剔除术。子宫肌瘤异常肥大的子宫肌瘤患者均选择子宫肌瘤剔除术，根据是否有残留分成残留组和非残留组，收集入组者的基准资料，包括年龄，体重指数，病理类型，子宫组织。所有患者均签署知情同意书，符合本院伦理学要求。
① 经B超诊断为子宫肌瘤，瘤体大小 > 5 cm，并且伴有临床症状，比如月经的改变，腹痛，腹胀，肛门坠胀感等，需要手术切除；
② 均为育龄期子宫肌瘤患者；
③ 入组者无明显的心肺功能疾病，比如肺功能不全，心功能不全，肾功能不全等疾病，可以耐受手术治疗；
④ 入组者患者无血液类疾病，比如再生障碍性贫血，白血病，凝血功能障碍等疾病，术后出血发生率极高；
⑤ 入组者无严重的心理疾病，包括人格分裂等心理疾病；
⑥ 入组者均对研究的内容和目的，同意研究方案，并签署知情同意书。
① 子宫肌瘤的瘤体大小 < 5 cm，并且不存在临床症状的患者，可以保守治疗；
② 诊断不明确的患者，比如子宫腺肌病患者；；
③ 心肺功能不全的子宫肌瘤患者；
④ 不同意该研究方案，拒绝服从医护指导的患者；
⑤ 未签署知情同意书的患者。
收集入组者的基准资料，包括年龄，体重指数，病理类型，子宫肌瘤的位置，大小和直径。
1) 育龄期子宫肌瘤继续增长：定义为绝经后1年以上，再复查B超至少2次提示子宫肌瘤增长；
2) 子宫肌瘤剔除术后残留：定义为子宫肌瘤剔除术后3月内，利用腹部B超进行检测，仍旧显示子宫肌瘤存在。
数据统计采用Excel表格，数据分析采用SPSS 23.0软件，对于符合正态分布的资料：计数资料采用平均值 ± 标准差(x ± s)进行统计，继续增长组和非继续增长组平滑肌瘤患者的一般基准资料比较采用t检验，残留组和非残留组平滑肌瘤患者的一般基准资料比较采用t检验，利用多因素Logistic回归分析体重，子宫肌瘤数目，肌瘤直径等指标与子宫肌瘤继续增长和复发的相关性，认为P < 0.05具有统计学差异。
入组的331例育龄期患者中，有54例子宫肌瘤患者出现育龄期后异常肥大，育龄期后子宫肌瘤异常肥大率为16.31%。
单因素分析结果显示，超重，子宫肌瘤数目 ≥ 5个，最大肌瘤直径，富于细胞型子宫肌瘤是育龄期子宫肌瘤继续增长的高危因素(P < 0.05)，见表1。
| 相关指标 | 继续增长组(n = 54) | 非继续增长组(n = 543) | 统计值 | P值 |
|---|---|---|---|---|
| 年龄 | 56.33 ± 3.09 | 35.98 ± 3.45 | t = 0.981 | >0.05 |
| 体重指数 | c2= 2.076 | <0.05 | ||
| 消瘦 | 10 (18.51%) | 54 (19.49%) | ||
| 正常 | 15 (27.78) | 221 (79.78%) | ||
| 超重 | 29 (53.71%) | 2 (0.73%) | ||
| 子宫肌瘤数目 | c2= 3.125 | <0.05 | ||
| <5个 | 8 (14.81%) | 250 (90.25%) | ||
| ≥5个 | 46 (85.19%) | 27 (9.75%) | ||
| 子宫肌瘤类型 | c2= 0.622 | >0.05 | ||
| 肌壁间 | 32 (59.26%) | 138 (49.82%) | ||
| 浆膜下 | 22 (40.74%) | 139 (50.18%) | ||
| 最大肌瘤直径 | 8.48 ± 1.12 | 6.09 ± 1.08 | c2= 2.325 | <0.05 |
| 病理类型 | c2= 2.446 | <0.05 | ||
| 普通型 | 26 (48.15%) | 136 (49.10%) | ||
| 富于细胞型 | 28 (59.09%) | 141 (50.90%) |
表1. 育龄期子宫肌瘤异常肥大的单因素分析结果
Logistic多因素分析结果显示，超重(OR = 1.736, 95%CI: 1.007~1.375, P = 0.026)，子宫肌瘤数目 ≥ 5 (OR = 1.126, 95%CI: 1.010~1.275, P = 0.031)，病理类型(OR = 1.024, 95%CI: 1.235~2.527, P = 0.024)是育龄期子宫肌瘤手术剔除术后继续增长的高危因素(P < 0.05)。见表2。
| 指标 | 回归系数 | 标准误 | Wald值 | P值 | OR值 | 95%CI |
|---|---|---|---|---|---|---|
| 超重 | 0.097 | 0.842 | 4.137 | 0.026 | 1.736 | 1.007~1.375 |
| 子宫肌瘤数目 | 0.087 | 0.035 | 4.564 | 0.031 | 1.126 | 1.010~1.275 |
| 最大肌瘤直径 | 1.422 | 0.843 | 2.532 | 0.116 | 1.432 | 0.974~1.426 |
| 病理类型 | 0.054 | 0.064 | 3.997 | 0.024 | 1.024 | 1.235~2.527 |
表2. 育龄期子宫肌瘤异常肥大的多因素分析结果
结果显示，入组的54例育龄期子宫肌瘤剔除术患者中，有18例子宫肌瘤患者出现术后残留，肌瘤术后残留率为33.33%。
结果显示，超重，子宫肌瘤数目 ≥ 5个，最大肌瘤直径，富于细胞型子宫肌瘤以及LncRNA ATB和LncRNA MEG3的高表达是育龄期子宫肌瘤手术剔除术后残留的高危因素(P < 0.05)，见表3。
| 相关指标 | 残留组(n = 18) | 非残留组(n = 36) | 统计值 | P值 |
|---|---|---|---|---|
| 年龄 | 55.67 ± 2.45 | 55.89 ± 3.14 | t = 0.308 | >0.05 |
| 体重指数 | c2= 2.783 | <0.05 | ||
| 消瘦 | 5 (27.78%) | 3 (8.33%) | ||
| 正常 | 4 (22.22%) | 28 (77.78%) | ||
| 超重 | 9 (50%) | 5 (13.89%) | ||
| 子宫肌瘤数目 | c2= 2.146 | <0.05 | ||
| <5个 | 1 (5.56%) | 30 (83.33%) | ||
| ≥5个 | 17 (94.44%) | 6 (16.67%) | ||
| 子宫肌瘤类型 | c2= 0.537 | >0.05 | ||
| 肌壁间 | 10 (55.56%) | 17 (47.22%) | ||
| 浆膜下 | 8 (44.44%) | 19 (52.78%) | ||
| 最大肌瘤直径 | 8.34 ± 1.04 | 6.67 ± 1.14 | c2= 2.427 | <0.05 |
| 病理类型 | c2= 3.231 | <0.05 | ||
| 普通型 | 7 (38.89%) | 21 (58.33%) | ||
| 富于细胞型 | 11 (61.11%) | 15 (41.67%) |
表3. 育龄期子宫肌瘤手术剔除术后残留的单因素分析结果
Logistic多因素分析结果显示，超重(OR = 1.945, 95%CI: 1.015~1.317, P = 0.037)，子宫肌瘤数目(OR = 1.374, 95%CI: 1.153~1.879, P = 0.028)，病理类型(OR = 1.653, 95%CI: 1.438~2.021, P = 0.021)是育龄期子宫肌瘤手术剔除术后残留的高危因素(P < 0.05)，见表4。
| 指标 | 回归系数 | 标准误 | Wald值 | P值 | OR值 | 95%CI |
|---|---|---|---|---|---|---|
| 超重 | 0.039 | 0.155 | 5.142 | 0.037 | 1.945 | 1.015~1.317 |
| 子宫肌瘤数目 | 0.099 | 0.042 | 4.974 | 0.028 | 1.374 | 1.153~1.879 |
| 最大肌瘤直径 | 1.439 | 0.807 | 2.024 | 0.108 | 1.516 | 0.914~1.232 |
| 病理类型 | 0.033 | 0.053 | 5.017 | 0.021 | 1.653 | 1.438~2.021 |
表4. 育龄期子宫肌瘤手术剔除术后残留的多因素分析结果
在传统认知中，育龄期女性子宫肌瘤有症状的患者，大多选择子宫全切。但是，对于新时代女性而言，越来越多的育龄期子宫肌瘤患者要求保留子宫，因为对她们而言，切除子宫会让他们有种性别认知的缺陷，造成一定程度的心理负担。但是对于子宫肌瘤剔除术患者而言，就要面对各种各样的并发症困扰，其中子宫肌瘤的继续增长是较为显著的问题。对于该类患者，最好的方法就是切除子宫，但是对于要求比较高的患者选择子宫肌瘤剔除术可以最大程度上保留子宫，满足患者的要求 [
子宫肌瘤是临床上的常见疾病，与腹部的疼痛和月经量过多密切相关 [
施兴华等人 [
综上所述，超重，子宫肌瘤数目 ≥ 5个，最大肌瘤直径，富于细胞型子宫肌瘤是育龄期子宫肌瘤异常肥大和子宫肌瘤手术剔除术后残留的高危因素。
卢翠华. 育龄期子宫肌瘤异常肥大和子宫肌瘤剔除术后残留的高危因素分析Analysis of High Risk Factors of Excessive Hypertrophy of Uterine Leiomyoma and Residual after Myomectomy in Child-Bearing Period[J]. 外科, 2022, 11(03): 76-82. https://doi.org/10.12677/HJS.2022.113013
https://doi.org/10.1111/apm.13114
https://doi.org/10.1016/j.amsu.2021.103007