Objective To compare the clinical effect of transcervical resection of the myoma （TCRM) and laparoscopic myomaectomy (LM) for type Ⅱ submucosal uterus myoma according to different diameter of myoma. Methods The clinical data of 299 patients with type Ⅱ submucosal uterus myoma who were admitted into our hospital from January 2010 to November 2018 were retrospectively analyzed.Among these patients

100 cases received laparoscopic surgery (laparoscopic group) and 199 cases received hysteroscopic surgery (hysteroscopic group).And the patients were divided into three subgroups according to the volume of uterus myoma.There were 149 cases in the small volume group (myoma diameter＜4 cm)

103 cases in the medium volume group (4 cm≤myoma diameter≤5 cm)

and 47 cases in the large volume group (myoma diameter＞5 cm).The clinical therapeutic effects of the three subgroups were compared according to two different surgical methods. The operative time

intraoperative blood loss

incidence of intraoperative change of operation method

rate of complete resection

incidence of serious complications

and recovery time of intestinal peristalsis were respectively compared.Results The small volume group: the operation time [(48.5±6.76) min vs.(57.8±8.02) min]

intraoperative blood loss[(67.9±12.48)mL vs.(74.6±10.46)mL]

and recovery time of intestinal peristalsis [(7.5±1.43) hours vs.(20.1±4.5) hours] of hysteroscopic group is significantly less than the laparoscopic group(P＜0.05);while the incidence of intraoperative transfer operation (1.6% vs.0)

the rate of complete resection(95% vs.100%)

and the incidence of serious complications (0.85% vs.0) in the two groups were of no significant difference (P＞0.05).The medium volume group:the recovery time of intestinal peristalsis of the hysteroscopic group had a slight advantage compared with that of the laparoscopic group [(8.19±1.56) hours vs.(18.56±3.86) hours](P＜0.05);and there was no statistically significant difference between the two groups in terms of the other indicators (P＞0.05).The large volume group:there was no statistically significant difference between the two groups

except for the incidence rate of intraoperative change of operation method (21%vs.7.1%).Conclusion Hysteroscopic surgery can remove myoma more quickly and thoroughly when the diameter of the myoma is less than 4 cm

with less intraoperative bleeding and faster postoperative recovery.And it has more obvious advantages in the treatment of small volumeⅡ type uterus myoma. However

with the increase of the myoma volume

the advantages of hysteroscopic surgery gradually decrease.When the diameter of myoma is 4 to 5 cm

the efficacy of hysteroscopic surgery and laparoscopic surgery is the same.In the large volume group

hysteroscopic surgery have no advantages in medical results compared with the laparoscopic surgery

and the risk of complications was significantly increased when the diameter of myoma is more than 5 cm.