ĐẶC ĐIỂM LÂM SÀNG VÀ CÁC YẾU TỐ LIÊN QUAN ĐẾN LỰA CHỌN PHƯƠNG PHÁP PHẪU THUẬT BÓC U XƠ CƠ TỬ CUNG TẠI BỆNH VIỆN PHỤ SẢN TRUNG ƯƠNG

Abstract

Objective: Description of clinical features and determinants influencing the selection of surgical approaches for uterine fibroid enucleation at the National Hospital of Obstetrics and Gynecology. Methods: A cross-sectional study was conducted on 292 patients undergoing myomectomy at the National Hospital of Obstetrics and Gynecology.  Results: The mean age of patients was 37.3 ± 6.2 years. The most common symptom was abnormal uterine bleeding (50%), followed by abdominal distension (27.7%). The majority had a single fibroid (80.1%), with tumors measuring 61–80 mm being the most frequent (31.5%). Open myomectomy accounted for 58.9%. Multivariate analysis showed that patients with preoperative Hb <120 g/L (OR = 0.50; 95%CI: 0.27–0.94; p = 0.030) and fibroid size ≥81 mm (OR = 0.34; 95%CI: 0.14–0.83; p = 0.018) were more likely to undergo open surgery, whereas fibroid size ≤40 mm strongly predicted hysteroscopic myomectomy (OR = 15.58; 95%CI: 2.28–106.2; p = 0.005). The mean operative time was 61.4 ± 21.6 minutes, with laparoscopic surgery being the longest and hysteroscopic surgery the shortest (p < 0.001). The average hospital stay was 4.6 ± 1.05 days, with longer stays observed in the open group (p < 0.05). Intraoperative transfusion was most frequent in open myomectomy (21.5%) and lowest in laparoscopy (7.4%) (p = 0.024). Postoperative complications were rare and did not differ significantly between groups. Conclusions: Myomectomy at the National Hospital of Obstetrics and Gynecology is safe and effective, with a low complication rate and improvement of preoperative anemia. Expanding the indications for minimally invasive surgery and optimizing preoperative management may further improve treatment outcomes.