[Analysis of 158 cases of hysteroscopic surgery for hysteromyoma]

To treat hysteromyoma by hysteroscopic surgery and to examine the treatment results in relation to the extent of surgery.

177 patients admitted from May, 1990 to Dec. 1994 for abnormal uterine bleeding caused by hysteromyoma were subjected to transcervical resection of myoma (TCRM) and/or transcervical resection of endometrium (TCRE). Except for 19 patients lost to follow-up, 158 patients were closely observed postoperatively. The mean follow-up was 29.3 months (range 5-60). These patients were divided into four groups according to the extent of the resected myoma. Analysis was based on 3 categories: the degree of bleeding control, the rate of growth of myoma and the need of subsequent surgery, and the treatment results were grouped into: perfection, satisfaction and dissatisfaction.

The growth of myoma and bleeding were controlled in 150 patients (94.9%) after resection. The result was much better than that of abdominal myomectomy. The treatment success of total resection of pediculate submucosal myoma was as high as 100%. If only > or = 50% of sessile submucosal myoma and intramural myoma were resected, the results of hysteroscopic surgery were satisfactory although there might be small residual intramural myoma or subserous myoma. Long term follow-up showed the residual myomata seemed to have stopped growing.

Transcervical resection is one of the effective treatments for abnormal uterine bleeding in hysteromyoma. Preoperative accuracy in appraisal of the extent of the myoma to be resected may help to correctly predict the prognosis and to improve the surgical cure rate.