不孕症合并子宫肌瘤的治疗进展

The Progress in Treatment of Infertility with Uterine Leiomyoma

子宫肌瘤是女性生殖系统最常见的良性肿瘤。随着生育年龄的推迟以及中国二胎政策的放开,不少子宫肌瘤患者在就诊时仍有生育要求,但此类患者的最佳治疗方式至今尚无定论。尽管国内外相关共识或指南中对不孕症合并子宫肌瘤的处理给予了一定的建议,但是这些建议也常模糊不清,有时甚至相互矛盾。有指南指出有生育需求的子宫肌瘤患者不推荐孕前行子宫肌瘤剔除术,除非子宫肌瘤曾导致妊娠并发症;有指南认为子宫肌瘤合并不孕就是治疗指征;而另有指南建议对于不孕症合并子宫肌瘤的治疗要根据子宫肌瘤的类型而定,建议对黏膜下肌瘤或引起宫腔形态改变的肌壁间肌瘤行手术治疗,其他部位肌瘤不论其大小均不建议治疗。现结合文献报道及相关指南建议,探讨不孕症合并子宫肌瘤的基本处理原则,为其规范化治疗提供参考。

Uterine leiomyoma is the most common benign tumor of female reproductive system.With the delay of childbearing age and the opening of China′s second child policy,many patients with uterine leiomyoma still have fertility requirements.However,the best treatment for such patients has not yet been determined.Although some suggestions have been given for the treatment of infertility with uterine fibroids in relevant consensus or guidelines at domestic and abroad,these suggestions are often ambiguous and sometimes contradictory.Some guidelines point out that hysteromyomectomy is not recommended for women with reproductive needs unless hysteromyoma has caused complications of pregnancy.Some guidelines consider that uterine fibroids combined with infertility is a treatment indication,while others suggest that the treatment of uterine fibroids with infertility should be based on the type of uterine fibroids.It is recommended to perform surgery on submucosal fibroids or intramural fibroids that cause changes in endometrium,and other areas of fibroids are not recommended to treat,regardless of the size of the fibroids.Based on the literature reports and relevant guidelines,this paper discusses the basic principles of treatment of infertility complicated with uterine leiomyoma,in order to provide reference for its standardized treatment.