子宫肌瘤剔除术后妊娠结局及相关影响因素

目的:分析影响子宫肌瘤术后妊娠的相关因素,比较不同手术方式的妊娠结局。方法:回顾分析2015年1月至2017年1月在南京医科大学附属无锡市妇幼保健院行子宫肌瘤剔除术的166例有生育要求的患者。采用单因素及多因素分析患者年龄、术前妊娠次数、是否合并不孕、肌瘤数目、最大肌瘤直径、肌瘤与子宫肌层的关系以及手术方式等对术后自然妊娠率的影响。比较腹腔镜子宫肌瘤剔除术组与经腹子宫肌瘤剔除术组的妊娠结局。结果:166例患者的术后总妊娠率48.80%,腹腔镜组、经腹组的术后妊娠率分别为44.00%(51/116)和60.00%(30/50),均未发生子宫破裂。患者年龄、最大肌瘤直径以及肌瘤位置与妊娠率相关(P<0.05)。腹腔镜组与经腹组患者的妊娠率、流产率和产科并发症无显著差异(P>0.05)。结论:年龄越大、最大肌瘤越大以及肌瘤位置越深越不利于妊娠,腹腔镜子宫肌瘤剔除术与经腹子宫肌瘤剔除术后妊娠结局相当。

Pregnancy outcome and related factors after myomectomy

Objective:To analyze the related factors affecting pregnancy after myomectomy and to compare the pregnancy outcome of different operation methods.Methods:A retrospective analysis was conducted on 166 patients with fertility requirements who underwent myomectomy in Wuxi Maternal and Child Health Hospital of Nanjing Medical University from Jan.2015 to Jan.2017.To analyze the relationship between natural fertility with clinical factors,including age of the patient,number of pregnancies before operation,infertility,number of fibroids,diameter of maximum fibroids,deep intramural localisation,and surgical method.The pregnancy outcomes of the laparoscopic myomectomy group(LM)and the transabdominal myomectomy group(TAM)was compared.Result:The pregnancy rate of 166 patients was 48.80%,thirty of the 50 patients(60.00%)who underwent TAM and 51 of the 116 patients who underwent LM(44.00%).Uterine rupture were not observed in our study.A statistically signifcant negative correlation was observed in relation to the association between patients'age,diameter of maximum fibroids,deep intramural localisation and the pregnancy rate(P<0.05).The pregnancy rate,the miscarriage rates and obstetric complications were not significantly different between TAM and LM groups.Conclusions:Age,maximum fibroid diameter and fibroid location are negatively correlated with pregnancy,and the pregnancy outcome after laparoscopic myomectomy was comparable to that after transabdominal myomectomy.