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目的:探讨子宫肌瘤剔除对妊娠的影响因素,分析生育结局和孕产期并发症的发生及转归,并对有生育要求子宫肌瘤患者的临床治疗和评估提供参考依据。方法:回顾性分析2005年6月~2010年5月在北京妇产医院微创中心行子宫肌瘤剔除术的患者的临床资料。40岁以下有生育要求并且尚未生育的患者共计227例,对其中不合并其他影响生育因素的152例患者研究术后妊娠的影响因素。对227例中妊娠的108例患者分析其生育结局和孕产期相关并发症发生及转归。结果:1年龄(P=0.000)及术前不孕史(P=0.011)是影响术后妊娠的因素,其中<35岁患者术后妊娠的可能性是≥35岁患者的9倍左右(OR=9.264,95%CI 3.783~22.683),术前无不孕史子宫肌瘤患者术后妊娠的可能性是肌瘤致不孕患者的3倍左右(OR=3.021,95%CI 1.288~7.082)。2宫腔镜、腹腔镜及开腹3种术式术后妊娠率比较无统计学差异(P=0.151,P>0.05)。3种术式并发症率无统计学差异(P=0.635,P>0.05)。结论:年龄和术前不孕史是子宫肌瘤剔除术后影响妊娠的主要风险因素,合并不孕的子宫肌瘤患者应尽早剔除肌瘤,提高妊娠率;腹腔镜、宫腔镜手术与开腹手术相比,术后妊娠率相当,且不增加孕产期并发症风险,是未生育女性较好的术式选择。
Objective: To investigate the influencing factors of fetus myomectomy on pregnancy, to analyze the occurrence and prognosis of reproductive outcomes and maternal complications, and to provide a reference for the clinical treatment and evaluation of patients with uterine fibroids requiring fertility. Methods: The clinical data of patients who underwent myomectomy at Minimally Invasive Center of Beijing Maternity Hospital from June 2005 to May 2010 were retrospectively analyzed. A total of 227 undergraduates aged under 40 who had fertility requirements and had not yet had childbirth were included in the study. The influencing factors of postoperative pregnancy were investigated in 152 patients without any other fertility factors. 108 cases of pregnancy in 227 cases of their reproductive outcomes and pregnancy-related complications and prognosis. Results: Age 1 (P = 0.000) and preoperative infertility (P = 0.011) were the factors influencing postoperative pregnancy, in which the probability of postoperative pregnancy was 35% = 9.264,95% CI 3.783 ~ 22.683), preoperative non-pregnancy history of uterine fibroids pregnant women after the possibility of infertility fibroids 3 times (OR = 3.021,95% CI 1.288 ~ 7.082). 2 hysteroscopy, laparoscopy and laparotomy three kinds of postoperative pregnancy rate was no significant difference (P = 0.151, P> 0.05). There was no significant difference in the three surgical complications (P = 0.635, P> 0.05). Conclusions: Age and preoperative infertility history are the main risk factors affecting pregnancy after myomectomy. In patients with uterine fibroids who have infertility, fibroids should be eliminated as soon as possible to improve the pregnancy rate. Laparoscopy, hysteroscopy and open Compared with abdominal surgery, postoperative pregnancy rate is quite high, and does not increase the risk of complications of pregnancy, is a better surgical options for non-pregnant women.