摘要
目的：通过组间对比研究,探讨子宫黏膜下和肌壁间肌瘤合并不孕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2006年6月~2013年6月该院妇产科接诊的94例子宫肌瘤合并不孕或流产患者的临床资料进行分析,其中黏膜下肌瘤44例,肌壁间肌瘤50例。本研究中行腹腔镜下肌壁间肌瘤切除术26例,行宫腔镜下黏膜下肌瘤电切术（TCRM）26例,行宫腔镜联合腹腔镜下黏膜下和肌壁间或浆膜下肌瘤切除术18例,开腹手术20例,经阴道手术4例。对患者术后妊娠情况及相关影响因素进行观察和分析。结果：术后共67例（71.3%）患者妊娠,其中肌壁间肌瘤患者妊娠率为62.0%（31/50）,黏膜下肌瘤患者妊娠率为81.2%（36/44）。67例妊娠患者中,自然流产3例、早产4例、异位妊娠1例、足月分娩59例,新生儿均存活,妊娠期和分娩期均无子宫破裂状况发生。患者不孕年限〉2年、年龄〉35岁、肌壁间肌瘤数目≥4个及最大直径≥6 cm者术后妊娠率明显降低（P〈0.05）,而黏膜下和肌壁间子宫肌瘤位置、手术时间、缝合层数及术中出血量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孕患者行子宫肌瘤切除术后,能够有效改善妊娠结局,患者不孕年限、年龄、肌壁间肌瘤大小和数目是术后妊娠率的影响因素。
Objective： To explore pregnancy outcome and influencing factors of patients with submucous myoma and intramural myoma combined with infertility after hysteromyomectomy by the comparison between the two groups. Methods： The clinical data of 94 patients with hysteromyoma combined with infertility or abortion in the hospital from June 2006 to June 2013 were analyzed,44 patients with submucous myoma and 50 patients with intramural myoma were included. Laparoscopic hysteromyomectomy of intramural myoma was performed among 26 patients,hysteroscopic transcervical resection of myoma（ TCRM） was performed among 26 patients,Laparoscopic / hysteroscopic hysteromyomectomy was performed among 18 patients,laparotomy was performed among 20 patients,transabdominal hysteromyomectomy was performed among 4 patients. The postoperative pregnancy condition and related factors were observed and analyzed. Results： After operation,67 patients（ 71. 3%） were pregnant,the pregnancy rates of patients with intramural myoma and submucous myoma were 62. 0%（ 31 /50） and 81. 2%（ 36 /44）,respectively. Among 67 pregnant women,three women were found with spontaneous abortion,four women were found with premature birth,one woman was found with ectopic pregnancy,59 full term women gave birth to their babies,all the neonates were alive,no uterine rupture occurred during pregnancy and delivery. The pregnancy rates of women with duration of infertility 2 years,age 35 years old,intramural myoma number≥4 and the maximum diameter≥6 cm decreased significantly（ P〈0. 05）; the position of myoma,operation time,number of layers and intraoperative bleeding volume were not correlated with postoperative pregnancy rate（ P〉0. 05）.Conclusion： After operation,hysteromyomectomy can effectively improve pregnancy outcome; duration of infertility,age,intramural myoma number and size are influencing factors of postoperative pregnancy rate.
出处
《中国妇幼保健》
CAS
2015年第9期1426-1428,共3页
Maternal and Child Health Care of China
