子宫腺肌病UAE治疗后妊娠及分娩的研究

The Outcome of Pregnancy after Uterine Arterial Embolization for the Treatment of Adenomyosis

目的：了解子宫腺肌痛子宫动脉栓塞治疗（UAE）后患者的妊娠情况及结局，探讨该治疗方法对生育功能的影响。方法：对我院所完成的252例因子宫腺肌病行UAE的病例进行追踪观察，了解治疗后妊娠情况及结局。结果：①252例患者中有13例共16次妊娠，均为自然受孕。受孕时间为术后3～43个月，平均为13个月。②没有生育要求的208例患者中，有4例（4次）意外受孕：2例（2次）药物流产，2例（2次）行人工流产术。其中1例行人工流产术的患者取其绒毛组织作染色体检查正常。③有生育要求的44例患者中有9例12次妊娠（妊娠2次者1例，妊娠3次者1例），受孕率为27．3％（12／44）。其中足月顺产分娩3例，足月要求剖宫产和术中切除子宫1例，因胎膜早破早产要求行剖宫产1例，此5例均未发生产后出血，新生儿常规体格检查均未发现异常。自然流产4例（4次），均为孕4个月内胚胎停止发育。目前正在妊娠中患者1例，该患者行血液唐氏综合征筛查风险值为1／780，B超符合孕周，发育良好。结论：子宫腺肌病UAE治疗后可以正常受孕和分娩，但可能存在流产和早产的高危因素。

Objective： To investigate the outcome of pregnancy after uterine arterial embolization（UAE） for the treatmerit of endometriosis, and to explore the impact of such treatment on women＇s fertility.Methods：252 women with endornetriosis undergoing UAE in our hospital were retrospectively analysed, their gestational activities and outcomes were recorded. Results： ① There were 16 times of pregnancies in 13 women of the total 252 patients, all of whom conceived spontaneously. ② Among 208 women who had no intention of conception, there were 4 times of unexpected pregnancies in 4 patients, among whom 2 cases underwent induced abortion by medication and the other 2 underwent surgical curettage. The villus tissue from one of these 4 induced abortions were taken for chromosome examine, in which no abnormality was found. ③ Among the 44 cases who had the desire of pregnancy, there were 12 times of pregnancies in 9 patients, the pregnancy rate was 27.3 %（12/44）. Three pregnancies ended by term vaginal birth; 1 patient demanded cesarean section after preterm premature rupture of membranes. Another patient asked for cesarean section in term pregnancy and underwent hysterectomy in the operation. No postpartum hemorrhage occurred in these 5 cases of term and preterm pregnancy. No abnormality was observed by routine physical examination of the 5 neonates. 4 cases underwent spontaneous abortion within the first 4 month of pregnancy. Right now, 1 pregnancy is still going on with normal fetal growth observed by ultrasound, the risk of Down＇ s syndrome obtained by screening test is 1/780. Conclusions,Women suffering from adenomyosis could have normal conception and delivery after UAE, but there might be high risks of spontaneous abortion and preterm delivery.