Predictors of leiomyoma recurrence after laparoscopic myomectomy

被引:132
作者
Yoo, Eun-Hee
Lee, Paul I.
Huh, Chu-Yeop
Kim, Dong-Ho
Lee, Byung-Seok
Lee, Jae-Kwan
Kim, Donguk
机构
[1] Kyung Hee Univ Med Coll, EW Neo Med Ctr, Dept Obstet & Gynecol, Seoul 134727, South Korea
[2] Cheil Gen Hosp, Seoul, South Korea
[3] Kyung Hee Univ, Med Ctr, Kyung Hee Univ Med Coll, Seoul, South Korea
[4] Chung Ang Univ, Med Ctr, Chung Ang Univ Med Coll, Seoul, South Korea
[5] Yonsei Univ, YoungDong Hosp, Coll Med, Seoul, South Korea
[6] Korea Univ, Med Ctr, Coll Med, Seoul, South Korea
[7] Sungkyunkwan Univ, Dept Stat, Seoul, South Korea
关键词
laparoscopic myomectomy; cumulative recurrence rate; cumulative reoperation rate; prognostic factors; recurrence;
D O I
10.1016/j.jmig.2007.06.003
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
STUDY OBJECTIVE: To evaluate recurrence and reoperation rate after laparoscopic myomectomy in relation to risk factors and identify suitable candidates for laparoscopic myomectomy to decrease recurrence. DESIGN: Multicenter retrospective cohort study (Canadian Task Force classification II-2). SETTING: Five university hospitals and a university-affiliated teaching hospital. PATIENTS: Five hundred and twelve women who underwent laparoscopic myomectomy between 1995 and 2004. All patients had a follow-up with clinical examination and transvaginal sonography for a median 13 months after surgery. I NTERVENTION: Laparoscopic myomectomy. MEASUREMENTS AND MAIN RESULTS: Recurrence was defined as the appearance of a leiomyoma on ultrasound examination or identification of leiomyoma during subsequent surgery after the initial surgery. Cox regression (full model) analysis of the possible risk factors for recurrence followed by a stepwise variable selection was performed to eliminate confounding factors. The cumulative probability of leiomyoma recurrence increased steadily during the follow-up period, 11.7% after 1 year, 36.1% after 3 years, 52.9% at 5 years, and reached 84.4% at 8 years. The cumulative probability of reoperation for recur-rent leiomyoma was much lower: 6.7% at 5 years and 16%, at 8 years. Significant risk factors that were independently associated with cumulative recurrence were age, preoperative number of myoma, preoperative uterine size by pelvic examination, presence of associated pelvic disease, and delivery after laparoscopic myomectomy. The operative time and change of hematocrit were associated with the reoperation. Those who had fewer than 2 myomas before surgery, uterus size less than 13 gestational weeks measured by pelvic examination, no childbirth after laparoscopic myomectomy, and age at index surgery less than 35.5 years showed the lowest recurrence after laparoscopic myomectomy from Classification and Regression trees analysis. CONCLUSION: The risk of recurrence of leiomyoma after laparoscopic myomectomy is linked with the age, preoperative number of leiomyoma, preoperative uterine size, presence of associated pelvic disease, and childbirth after surgery. (C) 2007 AAGL. All rights reserved.
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收藏
页码:690 / 697
页数:8
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