子宫肌瘤剔除术后妊娠的危险因素及妊娠者生育结局和孕产期相关并发症分析

Analysis on risk factors of pregnancy after myomectomy,fertility outcomes of pregnant women,and pregnancy-related complications

目的分析探讨子宫肌瘤剔除术后妊娠的危险因素及妊娠者生育结局和孕产期相关并发症。方法选取南通大学附属海安人民医院于2012年3月-2016年6月期间收治的229例有生育要求的子宫肌瘤患者,所有患者均进行子宫肌瘤剔除手术。将其中153例不合并其他影响生育因素的患者划分为甲组,109例妊娠患者划分为乙组,分析影响甲组患者术后妊娠的因素,并研究乙组患者孕产期相关并发症和生育结局。结果影响患者术后妊娠的风险因素主要为患者年龄和术前不孕史(均P<0.05),肌瘤类型以及肌瘤大小、数目和手术方式等并不是影响患者术后妊娠的风险因素(均P>0.05)。术后妊娠患者有109例(47.6%),距离手术首次妊娠间隔时间平均为(21.3±12.9)个月,其中活胎例数为94例(86.2%),流产例数为14例(12.8%),剖宫产例数为1例(0.9%)。足月儿例数为85例(90.4%),早产儿例数9例(9.6%);其中剖宫产例数为75例(79.8%),分娩例数为19例(20.2%)。开腹子宫肌瘤剔除(TAM)、腹腔镜下子宫肌瘤剔除(LM)和宫腔镜下子宫肌瘤剔除(TCRM)3种不同术式患者的孕产期并发症发生率分别为7.0%、13.3%和14.3%,差异无统计学意义(χ~2=2.316,P>0.05)。结论影响子宫肌瘤患者剔除术后妊娠的主要风险因素为年龄和术前不孕史,因此临床上对于合并有不孕症的子宫肌瘤患者应及时进行剔除手术,以提高其妊娠率。

Objective To analyze the risk factors of pregnancy after myomeetomy, fertility outcomes of pregnant women, and pregnan- cy-related complications. Methods A total of 229 uterine myoma patients with hearing requirement treated in Haian People＇s Hospital Affil- iated to Nantong University from March 2012 to June 2016 were selected, myomectomy was carried out. All the patients were divided into group A （ 153 patients without other influencing facors of pregnancy） and group B （ 109 pregnant women） . The influencing factors of preg- nancy after myomeetomy in group A were analyzed. The pregnancy-related complications and pregnancy outcomes in group B were also ana- lyzed. Results The main influencing factors of pregnancy after myomectomy were age and preoperative history of infertility （P〈0. 05 ） . The type, size, number of uterine myoma, and operation modes were not risk factors of pregnancy ＂after myomectomy （ all P〉0. 05 ） . A total of 109 women （47.6%） got pregnancy after myomectomy. The interval time of operation and pregnancy for the first time after operation was （21.3±12. 9） months. The proportions of live births, ＇abortion, and cesarean section cases were 86. 2% （94 eases） , 12. 8% （ 14 eases） , and 0. 9% （ 1 ease） . The proportions of full-term infants amt premature infants were 90. 4% （85 cases） and 9. 6% （9 cases） . The rates of cesarean section and vaginal delivery were 79.8% （75 cases） and 20. 2% （ 19 cases） . The incidence rates of pregnancy complications in patients undergoing transabdominal myomectomy （TAM） , laparoscopic hysteromyoma （LM） , and ranscervical resection of myoma （TCRM） were 7.0% , 13.3% , and 14. 3% , respectively, there was no statistically significant difference among the three groups （χ2 =2. 316, P〉 0. 05 ） . Conclusion The main risk factors of pregnancy after myomeetomy in patients with uterine myoma are age and preoperative history of infertility, so myomeetomy should be conducted timely to improve the pregnancy rate.