腹腔镜与经腹子宫肌瘤剔除术对有生育要求子宫肌瘤患者妊娠结局的影响及术后妊娠率的影响因素分析

Influence of Laparoscopy and Transabdominal Myomectomy on Pregnancy Outcome of Patients with Uterine Myoma Requiring Fertility and the Analysis of Influencing Factors of Postoperative Pregnancy Rate

目的:研究腹腔镜与经腹子宫肌瘤剔除术对有生育要求子宫肌瘤患者妊娠结局的影响及术后妊娠率的影响因素。方法:选取我院2018年4月至2021年4月收治的80例有生育要求的子宫肌瘤患者,其中接受经腹子宫肌瘤剔除术治疗的40例归为经腹组,接受腹腔镜子宫肌瘤剔除术治疗的40例归为腹腔镜组。比较两组手术疗效指标,术后并发症发生率以及术后妊娠率。此外,80例患者根据出院后1年是否妊娠分为妊娠组和未妊娠组,以多因素Logistic回归分析术后妊娠率的影响因素。结果:在术后失血量、肛门恢复排气时间以及住院时间方面比较,腹腔镜组均优于经腹组(P<0.05)。腹腔镜组术后并发症发生率低于经腹组(P<0.05),两组术后妊娠率对比无统计学差异(P>0.05)。单因素分析结果显示:年龄、肌瘤数目和子宫肌瘤剔除术患者术后是否妊娠有关(P<0.05),而孕次、肌瘤类型、肌瘤最大直径以及穿透宫腔与否和子宫肌瘤剔除术患者术后是否妊娠无关(P>0.05)。多因素Logistic回归分析结果显示:年龄≥35岁以及肌瘤多发是子宫肌瘤剔除术患者术后未妊娠的危险因素(P<0.05)。结论:腹腔镜与经腹子宫肌瘤剔除术对有生育要求子宫肌瘤患者妊娠结局的影响程度相当,但腹腔镜术式有助于患者术后康复,同时降低并发症发生风险。此外,年龄较大和肌瘤数目较多会使子宫肌瘤剔除术患者术后妊娠难度增加。

Objective:To study the influence of laparoscopy and transabdominal myomectomy on pregnancy outcome of patients with uterine myoma requiring fertility and the influencing factors of postoperative pregnancy rate.Methods:A total of 80 patients with uterine myoma with fertility requirements who were admitted to our hospital from April 2018 to April 2021 were selected.Among them,40 cases received transabdominal myomectomy were classified into the transabdominal group,and 40 cases received laparoscopy myomectomy were classified into the laparoscopy group.The operative efficacy indexes,postoperative complication rate and postoperative pregnancy rate were compared between the two groups.In addition,80 patients were divided into pregnant group and non-pregnant group according to whether they were pregnant 1 year after discharge,and the influencing factors of postoperative pregnancy rate were analyzed by multivariate Logistic regression.Results:Compared with the terms of postoperative blood loss,anal recovery exhaust time and hospital stay,the laparoscopy group was better than the transabdominal group(P<0.05).The postoperative complication rate in laparoscopy group was lower than that in transabdominal group(P<0.05).There was no significant difference in postoperative pregnancy rate between the two groups(P>0.05).The results of univariate analysis showed that age,the myoma numbers were related to whether the patient with pregnant after myomectomy(P<0.05),while the number of pregnancies,the myoma type,the maximum myoma diameter and whether they penetrated the uterine cavity were not related to whether the patient with pregnant after myomectomy(P>0.05).Multivariate Logistic regression analysis showed that age≥35 years and multiple myoma were the risk factors of patient with non pregnancy after myomectomy(P<0.05).Conclusion:Laparoscopy and transabdominal myomectomy have similar effects on the pregnancy outcomes of patients with uterine myoma with fertility requirements,but laparoscopy surgery can help patients recover after surgery and reduce the risk of complications.In addition,older age and more myoma numbers increase the difficulty of patients with pregnancy after myomectomy.