摘要
子宫肌瘤对不孕的影响与肌瘤的大小、位置及是否影响子宫内膜的容受性息息相关,子宫肌瘤可能通过改变局部解剖结构、引起异常收缩、改变内膜血流及局部高雌环境影响受孕。子宫肌瘤合并不孕的治疗方案需个性化,子宫肌瘤剔除术中注意保护卵巢,尽可能改善宫腔形态,尽量避免进入宫腔,尽量减少电热学仪器使用,尽量减少术后粘连。目前不孕患者的黏膜下肌瘤的治疗已达成共识,肌壁间肌瘤的治疗仍存在争议,尚需更多的对照研究。肌壁间肌瘤直径>4 cm、距子宫内膜<5 mm可以考虑行肌瘤剔除术。子宫肌瘤剔除术后有妊娠子宫破裂风险,术后避孕时间一般需6~12个月,肌壁间肌瘤较大、多发肌瘤、剔除肌瘤数≥3个及操作进入宫腔者,避孕时间建议1年,宫腔镜黏膜下肌瘤剔除术后避孕时间为3个月。
Uterine fibroids can cause female infertility by the size of the myoma, position and affect the receptive endometrium, uterine fibroids may affect the pregnancy by changing the local anatomic structure, abnormal shrinkage, the lining of the blood flow and local high female environment. The treatments on uterine fibroids combined infertility should be personalized, intraoperative pay attention to protect the ovaries, improve uterine form as much as possible, finally it should be try to avoid into the uterine cavity and minimize the electrothermal apparatus adhesion. The consensus of treatment of myoblastoma with infertile is still in dispute. The muscle wall fibroids diameter>4 cm and the distance to endometrium<5 mm may be considered for the removal of myoma. Eliminate postoperative uterine fibroids have risks of gravid uterus rupture, postoperative pregnancy time usually takes 6 to 12 months, as well as larger muscle intramural myoma, multiple myoma, eliminate fibroid number≥3 and fibroids in the uterus, needs longer contraceptive period for 1 year. Hysteroscopy submucosa was removed from the postoperative contraceptive period for 3 months.
出处
《中华临床医师杂志（电子版）》
CAS
2017年第10期1846-1850,共5页
Chinese Journal of Clinicians(Electronic Edition)
基金
卫生部公益性行业研究专项项目(2115000011)
