当院における子宮粘膜下筋腫に対する子宮鏡下手術の治療成績について

抄録

Objective: To evaluate the results of hysteroscopic surgery after introducing in our hospital in July 2012.

Methods: For the period from July 2012 to December 2016, we examined the surgical results of all hysteroscopic myomectomies and cases with myomas having maximum diameters of 30 mm or more and protrusion rates of 50% or less. A gonadotropin-releasing hormone agonist was administered preoperatively in all cases. Monopolar or bipolar hysteroresectoscopes were selected as required. The boundary portion between the myoma and normal muscle layer was peeled off at the tip of the loop electrode and removed with placental forceps after sufficient detachment.

Results: A total of 364 hysteroscopic surgeries were performed (uterine fibroids: 235, endometrial polyps: 124, intrauterine synechiae: 3, endometrial cautery: 2).

  With the analysis for uterine submucosal fibroids alone, 94.9% of all cases involved complete resection during initial surgery. Even in cases with myomas having a maximum diameter of 30 mm or more, and a protrusion rate of 50% or less, 87.0% had been excised during initial surgery.

Conclusions: We consider our technique useful for treating large, less-protruding submucosal myomas, which are generally considered difficult surgical cases. As a result, the indications for hysteroscopic myomectomy may be expanded.