高龄妇女不同术式治疗子宫腺肌瘤对术后妊娠的影响

Influence of different surgical methods for treating advanced women with adenomyosis on their pregnancy outcomes after surgery

目的:探究不同治疗方式对高龄子宫腺肌病患者妊娠的影响.方法:回顾性分析2011年12月1日-2016年12月1日本院行子宫腺肌病病灶切除术后有生育要求的35~45岁子宫腺肌病患者116例的临床资料,其中经腹子宫腺肌瘤局灶切除术52例为经腹组,腹腔镜下子宫腺肌瘤局灶切除术64例为腹腔镜组,同期住院分娩的未行手术治疗的子宫腺肌病合并妊娠患者78例为对照组.比较妊娠情况并分析影响因素.结果:116例经手术治疗后,术后2年内妊娠65例(56.0%),但经腹组与腹腔镜组术后6个月、1年及2年妊娠及复发率无差异(P>0.05);术后妊娠组年龄<40岁、术后未复发、术后病灶未残留及术后应用辅助生殖技术等占比高于未妊娠组(P<0.05),多因素logistic回归分析显示,年龄≥40岁、术后未应用辅助生殖为术后妊娠的危险因素(OR=3.580、4.927,P<0.05),术后未复发、术后病灶未残留为妊娠的保护因素(OR=0.220、0.173,P<0.05).手术后妊娠组早产(9.2%)、流产(13.9%)、低体重儿(10.7%)、前置胎盘(6.2%)、分娩感染(7.7%)、盆腔粘连(10.8%)发生率均高于对照(1.3%、2.5%、2.6%、0、0、1.3%)(均P<0.05).结论:高龄、术后复发、病灶残留及术后未使用辅助生殖技术均可影响子宫腺肌病患者术后妊娠,且术后妊娠患者发生不良妊娠结局偏高,因此对于高龄且有生育要求的子宫腺肌病患者可考虑带病妊娠.

Objective: To explore the influence of different surgical methods for treating advanced women with adenomyosis on their pregnancy outcomes after surgery. Methods: The clinical data of 116 advanced women with adenomyosis who had undergone adenomyosis focal resection and had fertility requirements from December 1, 2011 to December 1, 2016 were analyzed retrospectively. Among them, 52 women with transabdominal adenomyoma focal resection were in group A, and 64 women with laparoscopic adenomyoma focal resection were in group B. In addition, 78 pregnant women with adenomyosis who had hospitalized and delivered during the same period were selected in group C. The pregnant situation of the women was compared among the three groups, and the influencing factors were analyzed. Results: Among 116 women with adenomyosis who had undergone adenomyosis focal resection, 65(56.0%) women were pregnancy within 2 years after surgery. There were no significant differences in the rates of pregnancy and recurrence of adenomyosis of the women in 6 months, 1 year, and 2 years after surgery between group A and group B(P>0.05). The rates of age ≥40 years old, no recurrence of adenomyosis, no residual lesion, and assisted reproductive technology used of the women with postoperative pregnancy in group A and B were significant higher than those of the women without postoperative pregnancy(P<0.05). Multivariate logistic regression analysis showed that age ≥40 years old, and no assisted reproduction used after surgery of the women were the risk factors of their postoperative pregnancy(OR=3.580, 4.927, P<0.05). The no postoperative recurrence of adenomyosis and no postoperative residual lesion of the women were the protective factors of their postoperative pregnancy(OR=0.220, 0.173, P<0.05).The incidences of preterm birth(9.2%),abortion(13.9%),low birth weight(10.7%),placenta previa(6.2%),delivery infection(7.7%),and pelvic adhesions(10.8%)of the women in group A and group B were significantly higher than those(1.3%,2.5%,2.6%,0,0,and 1.3%)of the women in the control group(all P<0.05).Conclusion:Advanced age,postoperative recurrence of adenomyosis,residual lesions of adenomyosis,and no assisted reproductive technology used after surgery of the women with adenomyosis can affect their postoperative pregnancy,and these women after pregnancy have higher incidence of pregnancy adverse outcomes.Therefore,the advanced women with adenomyosis who have fertility requirements maybe try to pregnancy with the disease of adenomyosis.