经阴道子宫肌瘤剔除术后妊娠结局分析  

Pregnancy outcomes following transvaginal myomectomy

作　　者：邓凯贤[1] 柳晓春[1] 谢庆煌[1] 郑玉华[1] 黄小敏[1] 

机构地区：[1]广东省佛山市妇幼保健院妇科,广东佛山528000

出　　处：《中国实用妇科与产科杂志》2013年第6期447-449,共3页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的探讨有生育要求的子宫肌瘤患者实施经阴道子宫肌瘤剔除术后妊娠情况及结局,评估经阴道子宫肌瘤剔除术应用于有生育要求子宫肌瘤患者的安全性和可行性。方法选择2001年1月至2010年12月在佛山市妇幼保健院行经阴道子宫肌瘤剔除术、有生育要求并能完整随访的患者185例为研究对象,回顾性分析患者一般资料、术中所见子宫肌瘤情况、手术质量指标、术后妊娠情况及具体过程、分娩经过、分娩方式及并发症等各项指标。结果随访14个月至11年,185例患者中143例(77.30%)成功妊娠,共妊娠210次,其中131例(70.8%)自然受孕,12例(6.49%)经辅助生殖技术受孕;36例(19.46%)不孕;6例(3.24%)年轻患者术后至今避孕故未孕。210次妊娠中足月顺产89次,早产顺产4次,足月分娩阴道助产2次,足月剖宫产73次,早产剖宫产2次,自然流产7次,人工流产28次,孕25周胎儿畸形引产1次,异位妊娠4次。共得活婴170例,170次分娩中无一例发生子宫破裂。瘢痕子宫是剖宫产的主要指征。手术距妊娠间隔时间平均(15.9±8.4)(6～60)个月。活产者孕周平均(38.2±1.3)(29～41)周。结论经阴道子宫肌瘤剔除术创伤小,恢复快,经长期观察随访患者术后妊娠率高,对有生育要求的子宫肌瘤患者而言是一种安全、可行的手术方式。Objective To analyze effects of transvaginal myomectomy on fertility and pregnancy outcome. Evaluate the feasibility and safety of transvaginal myomectomy to myomas patients who wish to preserve their fertility. Methods Between January 2001 and December 2010,185 patients who had symptomatic uterine leiomyomas and wished to preserve their fertility were admitted for transvaginal myomectomy in the Maternal and Children＇ s Hospital of Foshan. The indications patients＇ general materials, operative performance, postoperative complications, fertility condition and pregnancy outcome of these patients were retrospectively analyzed. Results After following-up between 14 months and 11 years, 143 （77.30%） of the 185 patients tried actively to conceive and they produced 210 pregnancies. 131 （70. 8% ）Natural insemination, 12（6. 49% ） received assisted reproduction, 36 （ 19.46% ） infertility, 6 （ 3.24% ） contraception to now. there were 89 term vaginal deliveries, 73 term Caesarean sections, 2 , 4 preterm vaginal deliveries, 2 preterm Caesarean sections ,7 （3.33%）natural abortions ,28 artificial abortions ,4 ectopie pregnancies and 1 received induced labor at 25 pregnancy week for . 170 healthy infants were gotten . Caesarean sections rate is 44. 12% and the main . Caesarean sections indication is uterine scar. The median interval between the transvaginal myomectomy and the first pregnancy was 15.9 8.4 months （range 6-60 months）. The mean pregnancy week is 38.2 ± 1.3 （range from 29 week to 41 week） . Uterine rupture was not reported. Conclusion Transvaginal myomectomy is minimally invasive . Pregnancies after transvaginal myomeetomy were uneventful and no uterine ruptures were detected during a long-term follow-up. Patients can get a high pregnancy rates after the procedure. Transvaginal is a safe and feasible treatment option for selected patients wishing to preserve their ability to conceive.

关 键 词：经阴道子宫肌瘤剔除术 子宫平滑肌瘤 妊娠 子宫破裂 

分 类 号：R713.4[医药卫生—妇产科学]