摘要目的 探讨子宫黏膜下肌瘤新的分级评分法对宫腔镜子宫黏膜下肌瘤电切割术的临床指导意义.方法 以5个参数(肌瘤向肌层的扩展深度;肌瘤的大小;肌瘤的基底部占子宫壁的比例;肌瘤在子宫腔的位置;是否多发性肌瘤)组成的子宫黏膜下肌瘤的新分级评分法,回顾性地对490例宫腔镜子宫黏膜下肌瘤电切割术的患者进行评分并与欧洲妇科内窥镜学会(ESGE)分类法进行比较;以分析手术的时间、成功率以及并发症的差异.结果 ESGE分类法:0型的平均手术时间(28.4min)与Ⅰ型(36.8 min)或Ⅱ型(44 min)相比均较短,差异有统计学意义(P均＜0.01),但Ⅰ型的手术时间与Ⅱ型相比差异无统计学意义(P＞0.05);一次手术成功的概率,Ⅱ型与0型或Ⅰ型相比均有显著性降低(P均＜0.01),但0型和Ⅰ型之间差异无统计学意义.新分级评分法:B组的平均手术时间(64.1 min)与A组(30.1 min)相比明显延长,差异有统计学意义(P＜0.01);而一次手术成功的概率,B组与A组相比亦有极显著性降低(P＜0.01).结论 子宫黏膜下肌瘤新分级评分法比ESGE分类法更合理、更全面,但仍然需要更多大样本的前瞻性研究.

abstractsObjective To value a new presurgical classification system of submucons myomas for predicting the difficulty and the safety of hysteroscopic myomectomy.Methods The clinical data of 491 patients who underwent hysteroscopic resection of submucous myomas were analyzed.The myomas were classified according to the Classification of the European Society for Gynaecological Endoscopy(ESGE)and our group's new classification,which consists of five parameters.The possibility of total resection of submucous myoma,the operating time and the frequency of any complications were considered.Results The ESGE classification showed significant differences between the level 0 and level Ⅰ or Ⅱ(both P＜0.01).Hysteroscopic myomectomy was considered incomplete in 9 patients with myomas.The numbers of complete surgeries of level Ⅱ was significant lower compared to level 0 or level Ⅰ(P＜0.01).Using our new classification,the differences of both operating times and the numbers of complete surgeries between group B and A was significant(P＜0.01).Conclusion The new classification gives more clues as to the difficuhies of hysteroscopic myomectomy than the standard ESGE classification.Although a larger number of patients need to be evaluated by this classification.