798例子宫肌瘤临床分析
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摘要
目的:本文探讨了子宫肌瘤及肌瘤变性的临床特点和术式选择,从而总结子宫肌瘤临床诊治的经验。方法:对我院经手术及病理证实的798例子宫肌瘤患者的临床资料进行回顾性分析,应用SPSS软件进行统计分析。结果:本组资料中,子宫肌瘤患者年龄在30~50岁为674例(84. 46%)。无明显临床症状的患者为206例(25.82%)。术前超声诊断子宫肌瘤的确诊率为98.24%,误诊率1.38%。手术方式以子宫肌瘤切除术为主(50.25%),不同年龄段的患者术式选择不同, 20~30岁组子宫肌瘤切除术占96.97%;≥50岁组子宫全切术占69.23%。肌瘤的生长部位不同手术方法不同(P<0.05),多发性子宫肌瘤以子宫全切术为主(36.92%),单发性子宫肌瘤以肌瘤切除术为主(55%~70%),肌壁间肌瘤与浆膜下肌瘤术式的选择无明显差异(P>0.05)。子宫肌瘤D<5cm组选择微创手术的比D≥5cm组多(P<0.05)。肌瘤伴发变性的有68例,其中D≥5cm为62例(91.18%),变性组与无变性组的年龄分布、临床症状无统计学差异(P>0.05)。子宫肌瘤合并宫颈上皮内瘤样病变CIN有11例,合并子宫内膜癌有3例(0.37%)。结论:子宫肌瘤发病具有年龄集中趋势,多在30~50岁之间;部分患者无明显症状,对育龄期妇女进行定期体检,是早期发现子宫肌瘤的有效方法;B超是诊断子宫肌瘤的重要手段,检查时应注意与子宫腺肌瘤、卵巢瘤相鉴别,粘膜下肌瘤更适宜宫腔镜检查及治疗;子宫肌瘤切除术将成为治疗子宫肌瘤的主要术式,微创治疗方法是子宫肌瘤治疗的发展新方向;较大肌瘤易发生变性,且良性变性多无特殊临床表现,术前诊断较困难;对于欲保留子宫或宫颈的患者,术前应当常规行宫颈液基薄层细胞学检查,对于阴道有不规则流血且年龄较大的患者,术前常规行分段诊刮。
The uterine leiomyoma is the most common benign tumor in the female reproductive organs, also is one of most common benign tumors in the human body.Statistics have indicated, the disease incidence rate reaches as high as 25%~30%.The majority of patients demonstrate clinically significant symptoms, including abnormal uterine bleeding, Sequential anemia, sensations of pressure in the pelvic cavity, pain and the reproductive disability,ect. The prevalence has severely affected women’s healthy conditions.
At present, there’re not effective medicines can eradicate the uterine leiomyoma. For the uterine leiomyoma with clinical symptoms, the surgery is still the most important method of treatment. The surgery scope including myomectomy, subtotal-hysterectomy and total hysterectomy.The way of surgery may pass through the abdomen or the vagina ,as well as under the laparoscopy or the hysteroscope which developed in recent years.
This article has analyzed the clinical characteristic of the uterine leiomyoma and the degenerate leiomyoma.Through the analysis , this article has discussed the relationship of surgical approach with the patient’s age, the location and size of the leiomymomas, the pathologic type.The objective is summarizing the experience with diagnosis and treatment .
Method: The clinical data and pathological result of the medical records of 798 surgically treated patients from September 2006 to September 2007 were retrospectively reviewed. And the distribution of patient’s age, the clinical symptoms, the diagnostic method, the choice of surgical approach and the pathologic type have been discussed. Setting up the database base on the EXCEL software, carring on the statistical analysis with the SPSS software, the counting data uses theχ2 examination to test.
We got the results as follow: Among the 798 patients with uterine leiomyoma, the age concentrates in 30~50 years old women who are being in childbearing years,which occupies the total sample 84. 46%. In 798 cases,656 cases had clinical symptoms(82.20%),206 cases had no evident clinical symptoms(25.82%).In front of the surgery,784 cases(98.24%)were diagnosed as hysteromyoma with ultrasound , the error diagnostic rate is 1.38%.The main surgical method is myomectomy (50.25%).The surgical approach has statistic difference in different age section.The younger patient is,the bigger myomectomy accounting for the proportion is.In the group of 20~30 years, myomectomy accounts for 96.97%.The odder patient is,the bigger hysterectomy accounting for the proportion is, In the group of≥50 years , hysterectomy account for 69.23%.The uterine leiomyoma with different characteristic uses different surgical approach, The main surgical approach of the multiple leiomyoma is hysterectomy, occupies 36.92%(151/409). The main surgical approach of the single leiomyoma is myomectomy, approximately occupies 55%~70%.There is no obvious difference in the choice of surgical approach between intermural myoma and subserous myoma. All submucous myomas which diameter <5cm all use hysteroscopic myomectom as treatment,but the submucous myoma which diameter >5cm uses hysterectomy or subtotal-hysterectomy through the abdomen.The mini-trauma technology is suitable for the small myoma. The degenerate leiomyoma has 68 cases, accounts for 8.52%, the age distribution of normal uterine leiomyoma is similar to degenerate uterine leiomyoma. The clinical symptom is also similar. The degenerate leiomyoma which diameter is bigger than 4cm is 62 cases (91.1%).In this group of cases,the uterine leiomyomas which incorporate with cervical intraepithelial neoplasia(CIN) have 11 cases(1.38%),in which CINIII have 5 cases.There are 2 cases which make the TCT examination before operations,the resule is hight-grade squamous intraepithelial lesions. There are 4 cases which make the biopsy before operations diagnosed definitely as CINIII. There is one case which have not be diagnosed before operations, the pathological result after hysterectomy is hight-grade squamous intraepithelial lesions (CINIII),implicates the gland partially. Among the 798 patients with uterine leiomyoma,simple hyperplasia of uterine endometrium have 25 cases (3.13%),polypus of uterine endometrium have 22 cases (2.76%),endometrial carcinoma 3 cases (0.37%).Among the 3 cases,there are 2 cases which make fractional curettage before operations diagnosed definitely as endometrial carcinoma, there is one case which make fast pathology in operation,the resule is complex hyperplasia,the canceration partially.
We obtain the conclusion as follow: 1.The morbidity of uterine leiomyoma has the central tendency with age, most patients are between 30-50 year old; 2. The main symptom of uterine leiomyoma is the menstrual change, the vaginal bleeding, the pain, the hypogastric lump, sensations of pressure in the pelvic cavity and sequential anemia, but there are many patients without evident clinical symptoms.The physical examination which is very important for the woman at childbearing age, is the effective method to discover uterine leiomyoma early;3. The ultrasound is the most important diagnostic method of the uterine leiomyoma.We should pay attention to distinguishing uterine leiomyoma from adenomyoma, as well as ovarian tumor. Hysteroscopy is suitable for the examination of submucous myomas,as well as the treatment of submucous myomas; 4. Surgery is still the best therapy for uterine leiomyoma with clinical symptoms. The following factors should be considered when choosing to surgical appobache for uterine leromyomas:the age,reproductive requre,the location and size of the leiomymomas and so on.The main surgical appobache to treat uterine leiomyoma is myomectomy. The mini-trauma technology will be popularized in the application to treatment of uterine leiomyoma; 5. The bigger uterine leiomyoma is,the easier the degeneration is.And the benign degeneration has no special clinical manifestations.It is difficulty to diagnose degeneration of uterine leiomyomas befor operation;6. The patient who wants to retain the uterus or the cervix should be making TCT conventionally before operation.If the result has some suspicions, the patient should be making the cervical biopsy to obviate the cervical intraepithelial neoplasia or the early invasive carcinoma of cervix. The patient whose age is slightly big ,and whose vagina has bleeding irregularly, should be making fractional curettage conventionally to obviate the malignant pathological change of endometrium before operation.
The uterine leiomyoma is the most common benign tumor in the female reproductive organs, also is one of most common benign tumors in the human body.Statistics have indicated, the disease incidence rate reaches as high as 25%~30%.The majority of patients demonstrate clinically significant symptoms, including abnormal uterine bleeding, Sequential anemia, sensations of pressure in the pelvic cavity, pain and the reproductive disability,ect. The prevalence has severely affected women’s healthy conditions.
At present, there’re not effective medicines can eradicate the uterine leiomyoma. For the uterine leiomyoma with clinical symptoms, the surgery is still the most important method of treatment. The surgery scope including myomectomy, subtotal-hysterectomy and total hysterectomy.The way of surgery may pass through the abdomen or the vagina ,as well as under the laparoscopy or the hysteroscope which developed in recent years.
This article has analyzed the clinical characteristic of the uterine leiomyoma and the degenerate leiomyoma.Through the analysis , this article has discussed the relationship of surgical approach with the patient’s age, the location and size of the leiomymomas, the pathologic type.The objective is summarizing the experience with diagnosis and treatment .
Method: The clinical data and pathological result of the medical records of 798 surgically treated patients from September 2006 to September 2007 were retrospectively reviewed. And the distribution of patient’s age, the clinical symptoms, the diagnostic method, the choice of surgical approach and the pathologic type have been discussed. Setting up the database base on the EXCEL software, carring on the statistical analysis with the SPSS software, the counting data uses theχ2 examination to test.
We got the results as follow: Among the 798 patients with uterine leiomyoma, the age concentrates in 30~50 years old women who are being in childbearing years,which occupies the total sample 84. 46%. In 798 cases,656 cases had clinical symptoms(82.20%),206 cases had no evident clinical symptoms(25.82%).In front of the surgery,784 cases(98.24%)were diagnosed as hysteromyoma with ultrasound , the error diagnostic rate is 1.38%.The main surgical method is myomectomy (50.25%).The surgical approach has statistic difference in different age section.The younger patient is,the bigger myomectomy accounting for the proportion is.In the group of 20~30 years, myomectomy accounts for 96.97%.The odder patient is,the bigger hysterectomy accounting for the proportion is, In the group of≥50 years , hysterectomy account for 69.23%.The uterine leiomyoma with different characteristic uses different surgical approach, The main surgical approach of the multiple leiomyoma is hysterectomy, occupies 36.92%(151/409). The main surgical approach of the single leiomyoma is myomectomy, approximately occupies 55%~70%.There is no obvious difference in the choice of surgical approach between intermural myoma and subserous myoma. All submucous myomas which diameter <5cm all use hysteroscopic myomectom as treatment,but the submucous myoma which diameter >5cm uses hysterectomy or subtotal-hysterectomy through the abdomen.The mini-trauma technology is suitable for the small myoma. The degenerate leiomyoma has 68 cases, accounts for 8.52%, the age distribution of normal uterine leiomyoma is similar to degenerate uterine leiomyoma. The clinical symptom is also similar. The degenerate leiomyoma which diameter is bigger than 4cm is 62 cases (91.1%).In this group of cases,the uterine leiomyomas which incorporate with cervical intraepithelial neoplasia(CIN) have 11 cases(1.38%),in which CINIII have 5 cases.There are 2 cases which make the TCT examination before operations,the resule is hight-grade squamous intraepithelial lesions. There are 4 cases which make the biopsy before operations diagnosed definitely as CINIII. There is one case which have not be diagnosed before operations, the pathological result after hysterectomy is hight-grade squamous intraepithelial lesions (CINIII),implicates the gland partially. Among the 798 patients with uterine leiomyoma,simple hyperplasia of uterine endometrium have 25 cases (3.13%),polypus of uterine endometrium have 22 cases (2.76%),endometrial carcinoma 3 cases (0.37%).Among the 3 cases,there are 2 cases which make fractional curettage before operations diagnosed definitely as endometrial carcinoma, there is one case which make fast pathology in operation,the resule is complex hyperplasia,the canceration partially.
We obtain the conclusion as follow: 1.The morbidity of uterine leiomyoma has the central tendency with age, most patients are between 30-50 year old; 2. The main symptom of uterine leiomyoma is the menstrual change, the vaginal bleeding, the pain, the hypogastric lump, sensations of pressure in the pelvic cavity and sequential anemia, but there are many patients without evident clinical symptoms.The physical examination which is very important for the woman at childbearing age, is the effective method to discover uterine leiomyoma early;3. The ultrasound is the most important diagnostic method of the uterine leiomyoma.We should pay attention to distinguishing uterine leiomyoma from adenomyoma, as well as ovarian tumor. Hysteroscopy is suitable for the examination of submucous myomas,as well as the treatment of submucous myomas; 4. Surgery is still the best therapy for uterine leiomyoma with clinical symptoms. The following factors should be considered when choosing to surgical appobache for uterine leromyomas:the age,reproductive requre,the location and size of the leiomymomas and so on.The main surgical appobache to treat uterine leiomyoma is myomectomy. The mini-trauma technology will be popularized in the application to treatment of uterine leiomyoma; 5. The bigger uterine leiomyoma is,the easier the degeneration is.And the benign degeneration has no special clinical manifestations.It is difficulty to diagnose degeneration of uterine leiomyomas befor operation;6. The patient who wants to retain the uterus or the cervix should be making TCT conventionally before operation.If the result has some suspicions, the patient should be making the cervical biopsy to obviate the cervical intraepithelial neoplasia or the early invasive carcinoma of cervix. The patient whose age is slightly big ,and whose vagina has bleeding irregularly, should be making fractional curettage conventionally to obviate the malignant pathological change of endometrium before operation.
引文
[1]Miller CE. Myomectomy: comparison of open and laparoscopic techniques [J]Obstet Gynecol Clin North Am,2000,27:407-420.
[2]Dubuisson JB,Fauconnier A,Fourchotte V, et al. laparoscopic myomectomy: predicting the risk of conversion to open procedure[J]. Hum Reprod, 2001,16:1727-1731.
[3]乐杰.妇产科学〔M〕·北京:人民卫生出版社,2004:296.
[4]DeLeoV,MorganteG.Uterine fibroids and the hormonal pattern: the praeutic considerations[J].Minerva Ginecol,1996,48:533.
[5]尚丽新,张忠福,王德智,等.子宫肌瘤患者血清性激素水平的变化.中华妇产科杂志,1995,30(4):233-234.
[6]姚慧.6671 例已婚妇女妇科普查子宫肌瘤发病情况分析.医学文选,2000,19(2):220-221.
[7]张鸿艳.超声诊断子宫肌瘤的临床价值.河北医药 2006,28(6):481.
[8]孙翠云,王新允,赵敏,王爱香,吴兴业.女性生殖系统肿瘤 9504 例临床病理分析[J]. 中国实用妇科与产科杂志, 2005,(03).
[9] 李 迎 春 , 金 亦 . 子 宫 肌 瘤 390 例 临 床 分 析 . 实 用 医 学 杂志.2005,21(6)609-610.
[10] 黄 乔 华 , 陈 禄 英 .310 例 子 宫 肌 瘤 临 床 分 析 . 中 国 妇 幼 保 健2007,22582-583.
[11]陈常佩,陆兆龄,主编.妇产科彩色多普勒诊断学.北京:人民卫生出版社,1998:43 .
[12]Nezhat CH, Nezhat F, Seidman DS, et al. Vaginal vault evisceration after total laparoscopic hyaterectomy[J].Obstet Gynecol,1996,87:86.
[13]Sutton C.Subtotal hysterectomy revisited[J].ENdosc Surv AlliedTechnol,1995,3(2-3):105.
[14]Wexler AS, Pernoll ML. BEnogn desorders of the uterine corpus. In: Current Obstet and Gynecol Diagnosis and Treatment. 8thed.Decherney (editer) [M].Appleton and LAnge,1994:731-743.
[15]曹斌融,张惜阴.子宫肌瘤红色变性的诊断与处理.实用妇产科杂志,1992,8(2):65.
[16]DisaisaPJ. Endometrialsarcoma: lymphaticspread pattern Am J Obstet Gynecol,1978,130:104.
[1]Carlson KJ,NicholsDH,Schiff I.Indications for hysterectomy[J]. NEng J Med,1993,328:856.
[2]Nezhat CH, Nezhat F, Seidman DS, et al. Vaginal vault evisceration after total laparoscopic hyaterectomy[J].Obstet Gynecol,1996,87:86.
[3]陈常佩,陆兆龄,主编.妇产科彩色多普勒诊断学.北京:人民卫生出版社,1998:43.
[4]苏应宽,徐增祥,江森.新编实用妇科学[M].济南:山东科学技术出版社,1995.376-377.
[5]Sutton C.Subtotal hysterectomy revisited[J].ENdosc Surv Allied Technol, 1995,3(2-3):105.
[6]Aldridge AH, Meredith RS. Complete abdominal hyster- ectomy[J].Am J Obstet Gynecol,1950,59:748.
[7]赵铀.筋膜内全子宫切除术的应用[J]. 实用妇产科杂志,2000,16(2):65-66.
[8]吴诗琦,李妍,陈永莲,等.筋膜下脱袖式子宫全切术式探讨[J].中国实用妇科与产科杂志,1996,12(2):111-112.
[9]苏莹,马兰,杨丽华,等.改良筋膜内子宫切除术 100 例观察.[J].临床外科杂志,2004,12(5):304-305.
[10]冯泽蛟.筒状宫颈旋切刀在筋膜内全子宫切除术中的应用[J].实用妇产科杂志,2004,20(2):99.
[11]沈红,赵海燕,杨志,等.经腹保留子宫动脉上行支的改良子宫全切除术价值探讨[J].中国妇幼保健,2003,12(10):598.
[12]刘新民,宋少梅.保留子宫内膜的手术[J].现代妇产科进展,1995,4:177.
[13]Wexler AS, Pernoll ML. BEnogn desorders of the uterine corpus.In:Current Obstet and Gynecol Diagnosis and Treatment. 8thed. Decherney (editer)[M].Appleton and LAnge,1994:731-743.
[14] 李 秀 兰 . 经 腹 小 切 口 子 宫 粉 碎 性 切 除 术 [J]. 临 床 军 医 杂 志 , 2003,31(2):29-30.
[15]Dubuisso JB, Fauconnier AO, Babakifard K, et al. Laparoscopic myome- ctomy: a current view[J].Hum Reprod Update,2000,6:588-594.
[16]Romer T.Hysteroscopic myoma resection of submucous myomas with largely intramural components.Zentralbl Gynaeko,1997,119:374-377.
[17]王晓雷,李丽宏,丛涛,等.宫腔镜治疗粘膜下子宫肌瘤的临床研究[J].中国实用妇科与产科杂志,2002,18(9):550.
[18]Ravina JH, Herbreteau D, Ciraru-Vigneron N,et al. Lancet, 1995,346 (8976): 671.
[19]陈晓明,杜娟,洪淡华.经导管子宫动脉栓塞治疗子宫肌瘤.国外医学.妇产科分册, 2001, 28 (2): 97.
[20]李广太,杨秀玉.子宫动脉栓塞术治疗子宫肌瘤的进展及评价.中华妇产科杂志, 2002, 37 (1): 58.
[21]Dover RW, Torode HW, Briggs GM. Uterine artery embolisation for symptomatic fibroids[J]. Med J Aust, 2000, 172(5): 233-236.
[22]杨华光,井红鸽,李 冰,等.阔韧带内巨大子宫肌瘤行介入栓塞术导致卵巢坏死的诊治[J].医学研究生学报, 2003, 16(12): 956-959.
[23]尹格平,陈铭,邵旭,等.射频热凝固微创技术治疗子宫良性病变的初步研究[ J].现代妇产科进展, 2003, 12(3):200-203.
[24]阎凯麟,张昕,孙涛.超声引导多弹头射频治疗子宫肌瘤 2 例[J].中国超声诊断杂志, 2002, 3(2): 143-144.
[25]刘平,张俊发,戴秋玲,等.微波治疗宫颈肌瘤[J].中华物理医学与康复杂志, 2000, 22(6): 382.
[26]白广德,谢爱玲,谢桂珍,等.腹腔镜引导经皮氩氦靶向治子宫肌瘤 5 例[J].广西中医学院学报, 2004, 7(1): 32-34.
[27]常淑芳,伍烽,白晋,等.高强度聚焦超声定位损伤离体人子宫肌瘤的研究[J].中国超声医学杂志, 2001, 17(2): 97-100.
[28]张娟,李世兰,黄河玲等.米非司酮治疗子宫肌瘤的临床研究[J].实用妇产科杂志,1999,15(2):75.
[29]岳天浮.子宫肌瘤的性激素治疗.中国实用妇科与产科杂志,2000, 16 (9): 520.
[30]王友芳.子宫肌瘤的药物治疗.中国医刊, 2002, 37 (4): 15.
[31]Ronald T,Urkman MD.MAnangment of the fibroid uterus [J].Current Problems in Obster Gynecol and Fertil,1998, 21 (2):31.
[32]谢红宁,车艳玲,刘杰,等.超声引导下瘤内无水乙醇注射治疗子宫肌瘤的初步研究[J].中国实用妇科与产科杂志,2000,16(4): 225.
[33] 韩惠兰 , 于飞 . 子宫肌瘤的中医治疗 [J]. 中国实用妇科与产科杂志,2001,17(3):126.
[2]Dubuisson JB,Fauconnier A,Fourchotte V, et al. laparoscopic myomectomy: predicting the risk of conversion to open procedure[J]. Hum Reprod, 2001,16:1727-1731.
[3]乐杰.妇产科学〔M〕·北京:人民卫生出版社,2004:296.
[4]DeLeoV,MorganteG.Uterine fibroids and the hormonal pattern: the praeutic considerations[J].Minerva Ginecol,1996,48:533.
[5]尚丽新,张忠福,王德智,等.子宫肌瘤患者血清性激素水平的变化.中华妇产科杂志,1995,30(4):233-234.
[6]姚慧.6671 例已婚妇女妇科普查子宫肌瘤发病情况分析.医学文选,2000,19(2):220-221.
[7]张鸿艳.超声诊断子宫肌瘤的临床价值.河北医药 2006,28(6):481.
[8]孙翠云,王新允,赵敏,王爱香,吴兴业.女性生殖系统肿瘤 9504 例临床病理分析[J]. 中国实用妇科与产科杂志, 2005,(03).
[9] 李 迎 春 , 金 亦 . 子 宫 肌 瘤 390 例 临 床 分 析 . 实 用 医 学 杂志.2005,21(6)609-610.
[10] 黄 乔 华 , 陈 禄 英 .310 例 子 宫 肌 瘤 临 床 分 析 . 中 国 妇 幼 保 健2007,22582-583.
[11]陈常佩,陆兆龄,主编.妇产科彩色多普勒诊断学.北京:人民卫生出版社,1998:43 .
[12]Nezhat CH, Nezhat F, Seidman DS, et al. Vaginal vault evisceration after total laparoscopic hyaterectomy[J].Obstet Gynecol,1996,87:86.
[13]Sutton C.Subtotal hysterectomy revisited[J].ENdosc Surv AlliedTechnol,1995,3(2-3):105.
[14]Wexler AS, Pernoll ML. BEnogn desorders of the uterine corpus. In: Current Obstet and Gynecol Diagnosis and Treatment. 8thed.Decherney (editer) [M].Appleton and LAnge,1994:731-743.
[15]曹斌融,张惜阴.子宫肌瘤红色变性的诊断与处理.实用妇产科杂志,1992,8(2):65.
[16]DisaisaPJ. Endometrialsarcoma: lymphaticspread pattern Am J Obstet Gynecol,1978,130:104.
[1]Carlson KJ,NicholsDH,Schiff I.Indications for hysterectomy[J]. NEng J Med,1993,328:856.
[2]Nezhat CH, Nezhat F, Seidman DS, et al. Vaginal vault evisceration after total laparoscopic hyaterectomy[J].Obstet Gynecol,1996,87:86.
[3]陈常佩,陆兆龄,主编.妇产科彩色多普勒诊断学.北京:人民卫生出版社,1998:43.
[4]苏应宽,徐增祥,江森.新编实用妇科学[M].济南:山东科学技术出版社,1995.376-377.
[5]Sutton C.Subtotal hysterectomy revisited[J].ENdosc Surv Allied Technol, 1995,3(2-3):105.
[6]Aldridge AH, Meredith RS. Complete abdominal hyster- ectomy[J].Am J Obstet Gynecol,1950,59:748.
[7]赵铀.筋膜内全子宫切除术的应用[J]. 实用妇产科杂志,2000,16(2):65-66.
[8]吴诗琦,李妍,陈永莲,等.筋膜下脱袖式子宫全切术式探讨[J].中国实用妇科与产科杂志,1996,12(2):111-112.
[9]苏莹,马兰,杨丽华,等.改良筋膜内子宫切除术 100 例观察.[J].临床外科杂志,2004,12(5):304-305.
[10]冯泽蛟.筒状宫颈旋切刀在筋膜内全子宫切除术中的应用[J].实用妇产科杂志,2004,20(2):99.
[11]沈红,赵海燕,杨志,等.经腹保留子宫动脉上行支的改良子宫全切除术价值探讨[J].中国妇幼保健,2003,12(10):598.
[12]刘新民,宋少梅.保留子宫内膜的手术[J].现代妇产科进展,1995,4:177.
[13]Wexler AS, Pernoll ML. BEnogn desorders of the uterine corpus.In:Current Obstet and Gynecol Diagnosis and Treatment. 8thed. Decherney (editer)[M].Appleton and LAnge,1994:731-743.
[14] 李 秀 兰 . 经 腹 小 切 口 子 宫 粉 碎 性 切 除 术 [J]. 临 床 军 医 杂 志 , 2003,31(2):29-30.
[15]Dubuisso JB, Fauconnier AO, Babakifard K, et al. Laparoscopic myome- ctomy: a current view[J].Hum Reprod Update,2000,6:588-594.
[16]Romer T.Hysteroscopic myoma resection of submucous myomas with largely intramural components.Zentralbl Gynaeko,1997,119:374-377.
[17]王晓雷,李丽宏,丛涛,等.宫腔镜治疗粘膜下子宫肌瘤的临床研究[J].中国实用妇科与产科杂志,2002,18(9):550.
[18]Ravina JH, Herbreteau D, Ciraru-Vigneron N,et al. Lancet, 1995,346 (8976): 671.
[19]陈晓明,杜娟,洪淡华.经导管子宫动脉栓塞治疗子宫肌瘤.国外医学.妇产科分册, 2001, 28 (2): 97.
[20]李广太,杨秀玉.子宫动脉栓塞术治疗子宫肌瘤的进展及评价.中华妇产科杂志, 2002, 37 (1): 58.
[21]Dover RW, Torode HW, Briggs GM. Uterine artery embolisation for symptomatic fibroids[J]. Med J Aust, 2000, 172(5): 233-236.
[22]杨华光,井红鸽,李 冰,等.阔韧带内巨大子宫肌瘤行介入栓塞术导致卵巢坏死的诊治[J].医学研究生学报, 2003, 16(12): 956-959.
[23]尹格平,陈铭,邵旭,等.射频热凝固微创技术治疗子宫良性病变的初步研究[ J].现代妇产科进展, 2003, 12(3):200-203.
[24]阎凯麟,张昕,孙涛.超声引导多弹头射频治疗子宫肌瘤 2 例[J].中国超声诊断杂志, 2002, 3(2): 143-144.
[25]刘平,张俊发,戴秋玲,等.微波治疗宫颈肌瘤[J].中华物理医学与康复杂志, 2000, 22(6): 382.
[26]白广德,谢爱玲,谢桂珍,等.腹腔镜引导经皮氩氦靶向治子宫肌瘤 5 例[J].广西中医学院学报, 2004, 7(1): 32-34.
[27]常淑芳,伍烽,白晋,等.高强度聚焦超声定位损伤离体人子宫肌瘤的研究[J].中国超声医学杂志, 2001, 17(2): 97-100.
[28]张娟,李世兰,黄河玲等.米非司酮治疗子宫肌瘤的临床研究[J].实用妇产科杂志,1999,15(2):75.
[29]岳天浮.子宫肌瘤的性激素治疗.中国实用妇科与产科杂志,2000, 16 (9): 520.
[30]王友芳.子宫肌瘤的药物治疗.中国医刊, 2002, 37 (4): 15.
[31]Ronald T,Urkman MD.MAnangment of the fibroid uterus [J].Current Problems in Obster Gynecol and Fertil,1998, 21 (2):31.
[32]谢红宁,车艳玲,刘杰,等.超声引导下瘤内无水乙醇注射治疗子宫肌瘤的初步研究[J].中国实用妇科与产科杂志,2000,16(4): 225.
[33] 韩惠兰 , 于飞 . 子宫肌瘤的中医治疗 [J]. 中国实用妇科与产科杂志,2001,17(3):126.