腹腔镜下子宫肌瘤剔除术后妊娠结局的影响因素分析

Analysis of influencing factors of pregnancy outcome after laparoscopic myomectomy

目的探讨腹腔镜下子宫肌瘤剔除术后影响患者妊娠结局的相关因素。方法将100例行腹腔镜子宫肌瘤剔除术且有生育要求的患者根据术后是否妊娠分为妊娠组(n=25)与未妊娠组(n=75),对两组患者的临床资料进行比较,分析术后妊娠结局的影响因素。结果妊娠组与未妊娠组的BMI、肌瘤最大径、术前宫腔形态、复发情况比较,差异均无统计学意义(P>0.05)。两组的年龄、肌瘤个数、子宫切口数、盆腔粘连程度、肌瘤类型比较,差异均有统计学意义(P<0.05)。多因素分析结果显示,年龄、子宫切口数、盆腔粘连程度、肌瘤类型是术后妊娠的影响因素,患者术后的妊娠率会随着年龄的增加、子宫切口数的增多、盆腔粘连程度的加重而降低(P<0.05)。结论年龄、子宫切口数、盆腔粘连、肌瘤类型是影响腹腔镜子宫肌瘤剔除术后妊娠的主要因素,年龄较大、子宫切口数较多、黏膜下肌瘤、盆腔粘连程度严重者的术后妊娠率较低,如有必要可通过辅助受孕方式提高妊娠率。

Objective To explore the related factors affecting pregnancy outcome after laparoscopic myomectomy. Methods 100 patients with hysteromyoma who underwent laparoscopic myomectomy were divided into pregnant group(25 cases) and non-pregnant group(75 cases) according to whether they were pregnant or not. The clinical data of the two groups were compared and the influencing factors of pregnancy outcome were analyzed. Results There were no statistical significantly differences in BMI, maximum diameter of myoma, preoperative uterine cavity shape and recurrence between pregnant group and non-pregnant group(P>0.05). There were statistical significantly differences in age, number of myoma, number of uterine incisions, degree of pelvic adhesion and type of myoma between the two groups(P<0.05). Multivariate analysis showed that age, number of uterine incisions, degree of pelvic adhesion and type of myoma were the influencing factors of pregnancy after operation. The pregnancy rate of patients after operation decreased with the increase of age, number of uterine incisions and aggravation of pelvic adhesion(P<0.05). Conclusion Age, number of uterine incisions, pelvic adhesions and types of myoma are the main factors affecting pregnancy after laparoscopic myomectomy. Those with older age, more uterine incisions, submucosal myoma and severe pelvic adhesions have lower pregnancy rate. If necessary, the pregnancy rate can be increased by assisted pregnancy.