The Clinical Study Of Submucosal Myomectomy Of Type Ⅰ Submucosal Hysteromyoma With A Diameter Of 40-70mm Under Laparoscope And Hysteroscope

Objective:To compare and evaluate of clinical curative effect between hysteroscopy and laparoscopy when removing type I submucosal myoma with a diameter of 40-70mm,so that to seek for a better surgical method to cure this type submucosal myomMethods:26 cases,who were age from 27 to 46,were diagnosed with submucous myoma which average diameter is about 53.04±6.91mm,Needed to be treated surgically in our hospital from July 2015 to November 2018 and selected and divided into two groups according to the operation way.One was hysteroscopy group with 12 cases,the other was laparoscopic group with 14 cases.There two groups were compared with operation time,amount of bleeding,intraoperative endometrium injury,time of the anal,time of postoperative vaginal bleeding and postoperative vaginal bleeding time and ionic disturbance after operation in both groups.Follow up the endometrium recovery of the patients 2 months after surgery,imaging examination indicated that no abnormal endometrium was recorded as good,indicating that the fluid area,scar shadow,hypoechoic and residual endometrium were not recorded as good.The changes of menstrual cycle and menstrual volume 2 months after surgeryResults:There were statistically significant differences in operative time,anal exhaust time between two groups(P<0.05)that the laparoscopic group were more than those in hysteroscopygroup.Intraoperative blood loss,intraoperative no endometrial injury and postoperative vaginal bleeding time were compared between the two groups(P<0.05),and the difference was statistically significant.The time of intraoperative bleeding and postoperative vaginal bleeding in the laparoscopic group was significantly less than that in the hysteroscopy group.Endometrial injury in the laparoscopic group was significantly better than that in the hysteroscopy group.Among the 26 patients who underwent surgery,1 case had ionic disorder in hysteroscopy group and no ionic disorder in laparoscopy group.The percentage of good endometrial recovery and bad endometrial recovery was 58.33%and 41.67%,respectively,in the 12 patients in the hysteroscopy group 2 months after surgery.The percentage of endometrial recovery in 14 patients in the laparoscopic group was 100%Endometrial recovery after operation in the laparoscopic group and the hysteroscopic group was P<0.05,and the difference was statistically significant.The menstrual recovery of the two groups 2 months after surgery was P<0.05,and the laparoscopic group was better than the hysteroscopy group.Logistic multivariate regression analysis showed that surgical method was the influencing factor of postoperative menstrual recovery(P<0.05),OR=9.Conclusion:Both hysteroscopy and laparoscopy are safe and effective in the treatment of type I submucosal fibroids of 40-70mm.Laparoscopic surgery with pituitin combined with fibroid base ligation can significantly reduce the amount of intraoperative blood loss and postoperative vaginal bleeding time.In addition,such laparoscopic surgery has no damage to the endometrium and myometrium,and retains the integrity of endometrium and uterine cavity.The recovery time of menstruation after operation was shorter.Therefore,laparoscopic myomectomy may be beneficial to the postoperative pregnancy of young patients with larger type I submucosal fibroids who are required to give birth.