CAJ | 학술논문

目的：探讨子宫肌瘤剔除术后肌瘤残留及复发的相关危险因素。方法收集同期行腹腔镜或开腹子宫肌瘤剔除术并定期随诊408例患者的临床资料，记录其一般情况、肌瘤特征、手术方式、术后残留及复发情况，采用 logistic 回归分析术后肌瘤残留危险因素，采用 Cox 回归模型分析术后复发危险因素。结果腹腔镜与开腹子宫肌瘤剔除术的术后残留率、累积复发率比较差异均无统计学（P 均＞0．05）。肌瘤数目是子宫肌瘤剔除术后残留（OR ＝1．215，95％CI：1．145～1．278，P ＝0．023）及复发（RR ＝1．189，95％CI：1．065～1．246，P ＝0．034）的危险因素；肌瘤类型（肌壁间肌瘤）是术后复发危险因素（RR ＝4．654，95％CI：3．865～5．984，P ＝0．026）；年龄（年龄≥35岁）是术后复发危险因素（RR ＝2．976，95％CI：2．213～4．509，P ＝0．013）。结论腹腔镜和开腹子宫肌瘤剔除术均是保留子宫的安全、有效的治疗方式，腹腔镜并不增加肌瘤剔除术后的残留及复发危险，肌瘤数目≥4个是子宫肌瘤剔除术后残留的主要危险因素，肌瘤数目≥4个、肌壁间肌癌、患者年龄≥35岁是子宫肌瘤剔除术后复发的主要危险因素。
목적：탐토자궁기류척제술후기류잔류급복발적상관위험인소。방법수집동기행복강경혹개복자궁기류척제술병정기수진408례환자적림상자료，기록기일반정황、기류특정、수술방식、술후잔류급복발정황，채용 logistic 회귀분석술후기류잔류위험인소，채용 Cox 회귀모형분석술후복발위험인소。결과복강경여개복자궁기류척제술적술후잔류솔、루적복발솔비교차이균무통계학（P 균＞0．05）。기류수목시자궁기류척제술후잔류（OR ＝1．215，95％CI：1．145～1．278，P ＝0．023）급복발（RR ＝1．189，95％CI：1．065～1．246，P ＝0．034）적위험인소；기류류형（기벽간기류）시술후복발위험인소（RR ＝4．654，95％CI：3．865～5．984，P ＝0．026）；년령（년령≥35세）시술후복발위험인소（RR ＝2．976，95％CI：2．213～4．509，P ＝0．013）。결론복강경화개복자궁기류척제술균시보류자궁적안전、유효적치료방식，복강경병불증가기류척제술후적잔류급복발위험，기류수목≥4개시자궁기류척제술후잔류적주요위험인소，기류수목≥4개、기벽간기암、환자년령≥35세시자궁기류척제술후복발적주요위험인소。
Objective To discuss the risk factors for postoperative residue and recurrence in pa-tients with leiomyoma.Methods Clinical data including demographic information,leiomyoma characteristics, surgical approach,postoperative residue and recurrence were recorded from 408 women undergoing laparoscopic (LM)or transabdominal myomectomy (TAM)and regular follow-up.The risk factors for postoperative residue of leiomyoma were assessed by logistic regression analysis,and those for postoperative recurrence were evalua-ted by Cox regression analysis.Results There were no statistical differences in rates of postoperative residual and cumulative recurrence between LMand TAM(P >0.05).The number of leiomyoma was a risk factor for postoperative residue and recurrence of leiomyoma.The rate of postoperative residue was increased by 0.215 times (OR =1.215,95%CI:1.145 ~1.278,P =0.023)and that of postoperative recurrence was elevated by 0.189 times (OR =1.189,95%CI:1.065 ~1.246,P =0.034)when the number of leiomyoma was in-creased by one.The type of leiomyoma (intramural leiomyoma)(RR =4.654,95%CI:3.865 ~5.984,P =0.026)and age (≥35 years)(RR =2.976,95%CI:2.213 ~4.509,P =0.013)were risk factors for post-operative recurrence of leiomyoma.Conclusions Both LMand TAMare safe and effective surgical approaches for retaining the uterus of patients with leiomyoma.LMwould not increase the rates of postoperative residue or recurrence.The number of leiomyoma is the main risk factor for postoperative residue.The number and type of leiomyoma and patients’age serve as major risk factors for postoperative recurrence.