保守疗法与手术治疗妊娠期合并子宫肌瘤对妊娠结局影响的回顾性分析

Retrospective Analysis of the Influence of Conservative and Surgical Treatment on Pregnancy Outcome of Pregnancy Combined with Hysteromyoma

目的:探讨保守疗法与手术治疗妊娠期合并子宫肌瘤对妊娠结局的影响。方法:回顾性分析2015年6月-2017年8月笔者所在医院收治的160例妊娠期合并子宫肌瘤患者的临床资料,其中保守治疗86例(保守组),腹腔镜下子宫肌瘤剔除术治疗74例(腹腔镜组)。比较两组不良妊娠结局,并比较两组最大子宫肌瘤直径<6 cm和≥6 cm时的不良妊娠结局。结果:保守组流产或引产、早产、胎儿窘迫及新生儿窒息率、母体及围产儿总不良妊娠结局率均高于腹腔镜组(P<0.05),两组剖宫产及新生儿死亡率比较差异均无统计学意义(P>0.05);对于最大子宫肌瘤直径<6 cm的患者,两组流产或引产、早产、剖宫产、胎儿窘迫、新生儿窒息、死亡率、母体及围产儿总不良妊娠结局率比较,差异均无统计学意义(P>0.05);但对于最大子宫肌瘤直径≥6 cm的患者,保守组流产或引产、早产、胎儿窘迫及新生儿窒息率、母体及围产儿总不良妊娠结局率均高于腹腔镜组(P<0.05),两组剖宫产及新生儿死亡率比较差异均无统计学意义(P>0.05)。结论:对于最大子宫肌瘤直径<6 cm的妊娠期合并子宫肌瘤患者,保守疗法与手术治疗对妊娠结局的影响相似,但对于最大子宫肌瘤直径≥6 cm的患者,手术治疗对妊娠结局的改善作用优于保守疗法,临床治疗时应根据肌瘤大小及自身情况选择合适的治疗方式。

To explore the influence of conservative therapy and surgical treatment on pregnancy outcome of pregnancy combined with hysteromyoma.Method:The clinical data of160patients of pregnancy combined with uterine fibroids from June2015to August2017in our hospital were retrospective analyzed,and there were86cases of conservative treatment(conservative group)and74cases of laparoscopic myomectomy(laparoscopic group).The adverse pregnancy outcome of the two groups were compared,and the adverse pregnancy outcomes between of maximum uterine leiomyoma diameter<6cm and≥6cm of the two groupswere compared.Result:The rates of abortion or induced labour,premature delivery,fetal distress,neonatal asphyxia,maternal and perinatal infant adverse pregnancy outcome rate of the conservative group were significantly higher than those of the laparoscopic group(P<0.05),the cesarean section and neonatal mortality in two groups were compared,the differences were not statistically significant(P>0.05).For patients with the maximum hysteromyoma diameter<6cm,the rates of abortion or induced labour,premature delivery,cesarean section,fetal distress,neonatal asphyxia,neonatal mortality,maternal and perinatal infant adverse pregnancy outcome rate in two groups were compared,the differences were not statistically significant(P>0.05).For patients with the maximum diameter≥6cm,the rates of abortion or induced labour,premature delivery,fetal distress,neonatal asphyxia,maternal and perinatal infant adverse pregnancy outcome rate of the conservative group were significantly higher than those of the laparoscopic group(P<0.05),the cesarean section and neonatal mortality in two groups were compared,the differences were not statistically significant(P>0.05).Conclusion:For the patients of pregnancy combined with hysteromyoma with the maximum myoma diameter<6cm,the effects of conservative treatment and surgical treatment on pregnancy outcomes are similar,but the effect of surgical treatment on the improvement of pregnancy outcomes is better than that of conservative treatment when the patients with the maximum diameter≥6cm,and appropriate treatment should be selected according to the size of myoma and its own situation.