Цель исследования — оценка эффективности гистероскопической миомэктомии у пациенток с меноррагией в зависимости от размера субмукозного узла.
Размер миоматозного узла является базовой характеристикой субмукозной миомы матки и
может служить достоверным показателем на этапе формирования прогнозов выполнения гистероскопии. Одноэтапная резектоскопия пациенткам с субмукозной миомой до 25 мм — безопасная процедура, которая может проводиться с высокой эффективностью в условиях дневного стационара. У пациенток с диаметром узла более чем 30 мм ключевым параметром, который влияет на принятие решения об остановке операции на этапе ее выполнения, становится
длительность вмешательства. Лимитирующим показателем для оценки перспектив выполнения
гистероскопии в целом является длительность более чем 30 мин.
Purpose -- to evaluate the effectiveness of hysteroscopic myomectomy in patients with menorrhagia depending on the size of the nodule. 78 women with submucous myoma that underwent hysteroscopic myomectomy have taken part in
prospective observational study. Criteria’s inclusion were age from 18 to 49 years, diameter of nodules between 5 and 50 mm. Patients were divided into 5 groups depending on the size of the nodule:
Group I with the size of myoma from 5 till 10 mm; Group II: from 11 till 20 mm; Group III: from 21 till
30 mm; Group IV: from 31 till 40 mm; Group V: from 41 till 50 mm. To analyze the effectiveness of
myomectomy we evaluate the radicality of the procedure, the rate of complications, duration and fluid
deficit.
In patients with the nodules from 5 to 25 mm 91.5 % of the procedures lasted with the fluid deficit
less than 450 ml also the duration of hysteroscopy was less than 30 min among the 95.9% in this cohort. Among patients with size of myoma less than 30 mm in 98.3% of cases the fluid loss was
under 1500 ml and the duration of the procedure was shorter than 30 min in 90.5 % of cases. Two
episodes (30.0%) of fluid overload syndrome were reported in Group V.
The size of nodule is the major characteristic of submucous myoma. It can serve as a reliable
criteria to format the predictions of hysteroscopic myomectomy. In patients with the nodules less than
25 mm it is safe to perform effective one-stage procedures even in outpatient departments. It is mandatory to think about the possibility of stopping the procedure performing operation in case of myomas lager than 30 mm. The duration of hysteroscopy becomes the decision-making parameter in that
kind of situations. Duration more than 30 min is considered as a limitation factor.
