不同类型黏膜下子宫肌瘤患者宫腔镜手术治疗对妊娠结局的影响

Effect of hysteroscopy on the outcome of pregnancy in patients with different types of submucosal uterine fibroids

目的探讨不同类型黏膜下子宫肌瘤患者行宫腔镜手术治疗对妊娠结局的影响。方法选取2011年3月至2014年6月间深圳市龙岗区第六人民医院收治的162例黏膜下子宫肌瘤患者,均采用宫腔镜电切除术治疗。根据子宫肌瘤与肌层的关系,将患者分为0型组(78例)、Ⅰ型组(54例)、Ⅱ型组(30例),对3组患者的妊娠结局进行统计对比。结果 0型组患者的足月生产率、流产率、早产率和难产率与Ⅰ型和Ⅱ型组比较,差异均有统计学意义(均P<0.05)。Ⅰ型组与Ⅱ型组患者的足月生产率、流产率和早产率比较,差异无统计学意义(P>0.05)。但Ⅰ型组患者的难产率显著低于Ⅱ型组,差异有统计学意义(P<0.05)。3组患者均未发生子宫破裂(P>0.05)。结论不同类型黏膜下子宫肌瘤患者实施宫腔镜电切除术治疗的妊娠结局存在差异,带蒂肌瘤、肌层扩展越浅,患者的妊娠结局越好,提示黏膜下子宫肌瘤应当早诊断、早治疗。

Objective To explore the effect of hysteroscopy on the outcome of pregnancy in patients with different types of submucosal uterine fibroids. Methods From March 2011 to June 2014,162 patients with submucosal myoma of uterus in the Sixth People＇s Hospital of Longgang District were selected.All patients were treated by hysteroscopy. According to the relationship between the uterine fibroids and the muscular layer,the patients were classified into type 0 group（ 78 cases）,type Ⅰ group（ 54 cases） and type Ⅱ group（ 30 cases）. The pregnancy outcomes among the three groups were statistically compared.Results There were significant differences in the rate of term birth,abortion,premature delivery and difficult labor when comapring type Ⅰ group with either type Ⅱ or type 0 group（ P〈 0. 05）. There was no significant difference in the rate of term birth,abortion,and preterm birth between type Ⅰ and type Ⅱ groups（ P〈 0. 05）. However,the difficult labor rate in type Ⅰ group was significantly lower than that of type Ⅱgroup（ P〈 0. 05）. No uterine rupture occurred in the three groups（ P〉 0. 05）. Conclusions Pregnancy outcomes vary with different types of submucosal uterine fibroids. The shallower the extension of pedicle myoma and muscle layer,the better pregnancy outcome,suggesting that submucosal myoma of uterus should be diagnosed and treated at the early stage.