腹腔镜下子宫肌瘤切除术后不孕的风险因素分析

Analysis of Risk Factors for Infertility after Laparoscopic Myomectomy

目的:探讨腹腔镜下子宫肌瘤切除术后不孕的风险因素。方法:回顾性分析2021年1月—2023年3月在菏泽医学专科学校附属医院接受腹腔镜下子宫肌瘤切除的98例患者的临床资料,根据术后是否妊娠,将患者分为对照组(66例,妊娠)和研究组(32例,未妊娠)。对两组患者的临床资料进行单因素分析,并将有统计学意义的变量纳入多因素回归分析。结果:两组在肝功能状况、BMI、吸烟史、糖尿病史、手术时间、肌瘤位置方面差异无统计学意义(P>0.05);在年龄、宫腔形态、肌瘤类型、肌瘤直径、肌瘤数目、术中损伤输卵管、盆腔粘连和术后卵巢早衰方面差异均有统计学意义(P<0.05)。多因素回归分析显示,年龄≥35岁,宫腔形态异常,肌瘤直径≥10 cm,术中损伤输卵管,盆腔中重度粘连和术后卵巢早衰是导致腹腔镜下子宫肌瘤切除术后不孕的独立风险因素(P<0.05)。结论:年龄过高、宫腔形态异常、肌瘤直径过大、术中损伤输卵管、盆腔中重度粘连和术后卵巢早衰是腹腔镜下子宫肌瘤切除术后不孕的风险因素。针对这些因素的有效预防和管理对于降低术后不孕风险至关重要。

Objective:To explore the risk factors for infertility after laparoscopic myomectomy.Method:A retrospective analysis was conducted on the clinical data of 98 patients who underwent laparoscopic myomectomy at the Affiliated Hospital of Heze Medical College from January 2021 to March 2023.Based on postoperative pregnancy status,patients were divided into a control group(66 cases,who became pregnant)and a study group(32 cases,who did not become pregnant).A univariate analysis was performed on the clinical data of both groups,and variables with statistical significance were included in a multivariate regression analysis.Result:There were no statistically significant differences between the two groups in liver function status,BMI,smoking history,diabetes history,operation time,and fibroid location(P>0.05);there were statistically significant differences in age,uterine morphology,fibroid type,fibroid diameter,the number of fibroids,intraoperative damage to the fallopian tubes,pelvic adhesion,and postoperative ovarian failure(P<0.05).Multivariate regression analysis showed that age≥35 years,abnormal uterine morphology,fibroid diameter≥10 cm,intraoperative damage to the fallopian tubes,moderate to severe pelvic adhesion,and postoperative ovarian failure were independent risk factors for infertility after laparoscopic myomectomy(P<0.05).Conclusion:Higher age,abnormal uterine morphology,larger fibroid diameter,intraoperative damage to the fallopian tubes,moderate to severe pelvic adhesion,and postoperative ovarian failure are risk factors for infertility following laparoscopic myomectomy.Effective prevention and management of these factors are crucial for reducing the risk of postoperative infertility.