198例子宫肌瘤切除术患者术后肌瘤复发与部分患者妊娠结局分析

Analysis of recurrence and pregnancy of 198 cases after myomectomy

目的:探讨子宫肌瘤切除术后肌瘤复发的危险因素及其对妊娠结局的影响。方法:回顾性研究1999年1月1日—2007年12月31日行子宫肌瘤切除术且有随访资料的198例患者,分析其中术后妊娠者的妊娠结局。结果:平均随访30.9个月,复发73例(36.87%),复发时间距手术平均为23.1个月。复发者中术后随访<6个月和≥6个月的患者分别为4例(2.02%)和69例(34.85%)。术中发现肌瘤个数<2和≥2的复发患者分别为18例(9.09%)和55例(27.78%);年龄、妊娠分娩史、子宫肌瘤家族史、术前症状、合并症、手术方式、肌瘤部位、术后病理与复发无相关性(P>0.05)。80例术前有生育要求患者中,术后自然受孕并完成分娩者56例(70%),仍然不孕者17例(21.25%),肌瘤复发24例(30%),术后有足月妊娠且子宫肌瘤复发的患者5例(6.25%)。结论:肌瘤个数、大小与子宫肌瘤切除术后复发相关。子宫肌瘤切除术不影响术后受孕。术后有足月妊娠者复发率低。

Objective To investigate the risk factors related with recurrence of uterine myomas after myomectomy, and explore the pregnant outcome and the prognostic factors of the surgery. Methods One hundred and ninety-eight underwent myomeetomy were retrospectively analyzed. All the patients were followed up regularly after myomectomy and analyzed the pregnant outcome after surgery. Results The average time of follow-up was 30. 9 months. Seventy-three cases （36. 87%） recurred. The average time of recurrence was 23.1 months. Recurred cases with follow-up time 〈 6 months and ≥6 months were 4（2.02 %）and 69 （34.85 %）respectively. The recurrence rates of myoma number found in surgery less than 2 or more than 2 were 9.09% and 27. 78% respectively. There were no statistic difference between the recurrence and age, birth history, family history, symptoms, complications, modus operandi, tumor position and pathology. Natural pregnancy and delivery cases after myomectomy was 56 （70%）. Seventeen （21. 25%）cases still suffered from infertility. The recurrence rate was 30%. Recurrence rate about patients who had pregnant at term after surgery was 6.25%. Conclusion There are correlations between the recurrence rate and tumor number, tumor size, and the surgery does not affect pregnant. Patients with pregnant at term after myomectomy has lower recurrence rate.