影响子宫肌瘤剔除术后妊娠及其结局的因素

Research on the factors influencing pregnancy and its outcomes after myomectomy

目的探讨手术切除子宫肌瘤后妊娠的影响因素,分析切除肌瘤临床特征与术后不良妊娠结局的关系。方法以2009年10月至2017年12月于安徽医科大学附属妇幼保健院行子宫肌瘤剔除术,且术后停止避孕的286例患者为研究对象,收集其一般信息、手术资料,随访术后妊娠情况及分娩结局,分析影响术后妊娠的因素,探讨肌瘤临床特征与术后不良妊娠结局的关系。结果多因素非条件logistic回归分析发现年龄≥35岁、术前不孕不育就诊史为肌瘤剔除术后影响妊娠的独立危险因素。切除肌瘤的数目、穿透宫腔与否、大小不同,术后妊娠剖宫产率及不良妊娠结局发生率差异均无统计学意义(均P>0.05)。切除肌瘤的类型、术式不同,术后妊娠剖宫产率差异均有统计学意义(均P<0.05),不良妊娠结局发生率差异无统计学意义(均P>0.05)。结论子宫肌瘤剔除术对有生育要求的女性安全有效,但需结合自身不孕症因素及年龄综合考虑。

Objective To explore the influential factors of pregnancy after myomectomy,and to analyze the relationship between the clinical features of fibroids and the incidence of postoperative adverse pregnancy outcomes.Methods The clinical data on 286 patients who had undergone myomectomy in our hospital from October 2009 to December 2017 and stopped contraception after operation were analyzed retrospectively,including general information,clinical characteristics of fibroids,delivery patterns and postoperative pregnancy outcomes.The factors affecting postoperative pregnancy were analyzed;and the relationships between the characteristics of hysteromyoma and the incidence of postoperative adverse pregnancy outcomes was explored.Results Multi⁃factor unconditional logistic regression analysis found that age≥35 and infertility were independent risk factors for affect⁃ing pregnancy in patients after myomectomy.There were no significant differences in the amount of fibroid removal,presence or absence of fibroid penetration to the uterine cavity,size of fibroid,and rates of postoperative Cesarean section and adverse pregnancy outcomes(P>0.05 for all comparisons).There were statistical differences in types of forbids and different surgical procedures(P<0.05 for both comparisons).Conclusions Myomectomy is a safe and effective treatment for women who have fertility requirements,but infertility and age of these women should be carefully considered for this procedure.