摘要
目的了解子宫黏膜下和肌壁间肌瘤合并不育患者行子宫肌瘤切除术后的妊娠情况及影响妊娠的相关因素。方法对2000年1月至2012年12月河北医科大学第二医院妇产科113例子宫肌瘤合并不孕或流产患者的临床资料进行回顾性分析,其中黏膜下肌瘤53例,肌壁间肌瘤60例,行宫腔镜下子宫肌瘤电切术(TCRM)或经腹/腹腔镜/阴道子宫肌瘤切除术,观察术后妊娠及相关因素情况。结果 113例患者术后妊娠81例(71.7%),其中黏膜下肌瘤患者妊娠率为81.1%(43/53),肌壁间肌瘤患者妊娠率为63.3%(38/60)。81例妊娠患者中,71例足月分娩,6例早产,新生儿均存活。无子宫破裂发生。患者年龄>35岁、不孕年限>2年、肌壁间肌瘤最大直径≥6cm和数目≥4个者术后妊娠率明显降低(P均<0.05),而黏膜下和肌壁间子宫肌瘤位置、缝合层数、手术时间、术中出血量等与术后妊娠率无明显关系(P>0.05)。结论对黏膜下和肌壁间子宫肌瘤合并不育的患者行子宫肌瘤切除术可明显改善妊娠结局,患者年龄、不孕年限、肌壁间肌瘤大小和数目是术后妊娠率的影响因素。
Objective To evaluate pregnancy outcomes following myomectomy of submucosal and intramu ral myomata in infertile female patients. Methods A retrospective analysis of 113 patients hospitalized from January 2000 to December 2012 because of uterine myomata was conducted. The patients all had a history of infertility or miscarriage. Fifty-three patients with submucosal myoma underwent hysteroscopic myomectomy, and sixty patients with intramural myoma underwent myomectomy via laparoscopy, laparotomy, or vagina. All patients were followed- up and reproductive outcomes were recorded. Results Pregnancy rate was 71.7% （81/113） after myo- mectomy, and 81.1% （43/53） patients with submucosal myoma conceived, 63.3% （38/60） patients with intramural myoma were pregnant. Among the 81 cases of pregnant women, 71 cases had fullterm deliveries and 6 cases had premature deliveries. Anyway, all babies were alive. Uterine rupture was not found during pregnancy and labor. Patient age 〉35 years, infertility interval 〉2 years, maximum diameter of intramural myoma ≥6 cm and amounts ≥4 were negative factors of pregnancy after myomectomy （all P〈0. 05）. Conclusion Myomectomy can improve reproductive outcomes of infertile patients with submucosal or intramural myoma. Age, infertility interval, size and amount of intramural myoma are affecting factors to post- operative pregnancy.
出处
《中国妇产科临床杂志》
2014年第2期118-121,共4页
Chinese Journal of Clinical Obstetrics and Gynecology
