子宫肌瘤性不孕患者手术治疗研究进展

Progress in research on surgical treatment of infertility caused by uterine fibroids

子宫肌瘤是女性生殖器最常见的良性肿瘤，30岁以上的妇女约有20％发病，子宫肌瘤通过其解剖及功能方面的改变可影响妊娠结局，造成不孕。不同部位的子宫肌瘤对妊娠结局有不同的影响，包括子宫粘膜下肌瘤、子宫壁间肌瘤和子宫浆膜下肌瘤。粘膜下子宫肌瘤对生育有一定的不良影响，引起宫腔形态改变的肌壁间子宫肌瘤也影响生育，浆膜下子宫肌瘤对生育不良影响较小。对于子宫肌瘤合并不孕者，手术是一种重要的治疗方法，子宫肌瘤切除的分界标准及肌瘤性不孕患者手术方式的选择是近年研究的热点。该文对国内外近期有关子宫肌瘤性不孕及手术治疗的文献加以复习，主要介绍了近年来不同部位子宫肌瘤对妊娠结局影响的新观点，评价了各种手术对子宫肌瘤性不孕者的治疗价值及其最佳治疗时机。

Uterine fibroids are the most common genital benign tumor in female, about 20% of women aged over 30 years suffer from this disease. Uterine fibroids impact the pregnancy outcome through changing anatomy and function of the uterus, and result in infertility. Hysteromyomas in different parts of uterus （including submucous uterine fibroids, uterine leiomyoma and subserous uterine fibroids ） pose different effects on pregnancy outcome. Submucous uterine fibroids pose some adverse effects on fertility, leiomyoma that can distort the endometrial cavity also can cause infertility, subserous uterine fibroids pose little affection on fertility. For those patients with uterine fibroids associated with infertility, surgery is an important treatment. Threshold diameter of uterine fibroids to be removed and choice of pattern of operation have become a hot-spot in recent years. In this paper, we reviewed the recent domestic and foreign literatures concerning hysteromyoma caused infertility, and its surgical treatment and mainly introduced the new view points that fibroids in different parts of the uterus pose different effects on pregnancy outcome. Also, we indicated therapeutic values of every surgical procedures for those fibroids caused infertility and their most optimal surgical treatment time.