FIGO type 2 粘膜下筋腫に対して子宮鏡手術を併用したマイクロ波子宮内膜焼灼術の有用性

抄録

Objective: Heavy menstrual bleeding (HMB) is common in women of reproductive age, and can affect physical health and quality of life. Endometrial ablation (EA) has become one of the most commonly performed gynecologic procedures for HMB. However, leiomyoma with distorted uterine cavity affects efficacy, and especially in FIGO type 2 leiomyoma the surgery is not clearly defined. This study aimed to evaluate the long-term efficacy of EA combined with transcervical resection of uterine leiomyoma (TCRM) for HMB.

Design: A total of six women with HMB and distorted uterine cavities who failed medical treatment for FIGO type 2 leiomyoma underwent microwave endometrial ablation (MEA) combined with hysteroscopic myomectomy. Outcome measures were reintervention, hysterectomy, and complications followed for more than eight years.

Results: Backgrounds of cases were as follows: mean age 47.5±4 years (mean ± standard deviation), maximum diameter of fibroid 51±24 mm, protrusion degree of submucous fibroid 35±14％, uterine cavity length 87±17 mm. Finally, two of the six women undergoing MEA combined with TCRM required subsequent treatment. One had to undergo hysterectomy for dysuria after seven months without HMB, and the other had to take GnRHa for HMB continuously for seven months after initial treatment.

　Postoperative complications were one case of pelvic infection leading to cavity adhesion and amenorreha, and two cases of partial cavity adhesion. After microwave endometrial ablation with hysteroscopic resection, four patients went through menopause naturally 5.3±1 years after operation without additional treatment.

Conclusion: MEA combined with hysteroscopic myomectomy is effective for reducing heavy menstrual bleeding of FIGO type 2 leiomyoma. To reduce endometrial ablation failure and complications, further research is required to identify long-term prognostic factors and appropriate criteria for patient selection.