腹腔镜下子宫肌瘤剔除术后妊娠结局及相关因素分析  

Influencing factors of reproduction status of patients undergoing laparoscopic myomectomy

作　　者：宋光辉[1] 张松英[1] 李百加[1] 韦伟[1] 黄东[1] 林小娜[1] 楼红英[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院妇产科,杭州310016

出　　处：《中华医学杂志》2013年第35期2816-2819,共4页National Medical Journal of China

摘　　要：目的探讨腹腔镜下子宫肌瘤剔除术后妊娠结局及相关影响因素。方法回顾2004年1月至2012年12月在浙江大学医学院附属邵逸夫医院妇产科行腹腔镜下子宫肌瘤剔除术有生育要求的患者，共278例，已经妊娠87例，分析患者年龄、肌瘤部位、大小和个数与术后妊娠的关系，同时探讨手术技巧和妊娠结局。结果278例腹腔镜下子宫肌瘤剔除术无中转开腹，因子宫创面出血术后再次腹腔镜下缝合止血1例，术后3个月超声检查子宫切口均愈合，局部无不均质回声、积液和血肿形成；术中穿通子宫腔8例，术后3个月均经官腔镜检查无宫腔粘连；已经妊娠87例，术后妊娠时间2个月至5年3个月，按年龄分组妊娠率差异有统计学意义，而按肌瘤部位、大小和个数分类差异无统计学意义；术后妊娠的患者中，无妊娠期或者分娩期子宫破裂发生。结论需生育妇女行腹腔镜下子宫肌瘤剔除术是可以选择的，术后妊娠率与患者年龄相关。避免术后妊娠期或者分娩期子宫瘢痕破裂的关键在于术前超声的正确定位和恰当的手术操作。Objective To explore the influencing factors of reproduction status in women undergoing laparoscopic myomectomy （ LM ） . Methods A total of 278 LM patients were recruited. We retrospectively reviewed the reproduction status of 87 pregnant cases after LM. The correlations of their pregnancy outcomes and such clinical profiles as age, operative techniques, biological characteristics of fibroids （number, type, size and location） were analyzed. No uterine rupture occurred during the gestation period. Results None of them switched to open surgery due to laparoscopic difficulties. However, one patient had a laparoscopic suture for secondary bleeding of uterine incision. At 3 months post-operation, sonography showed no heterogeneous echo, effusion and hematoma in uterine incision. Incision through uterine cavity occurred intraoperatively in 8 cases, but no intrauterine adhesion was found on hysteroscopy 3 months later. And 87 women became pregnant and the postoperative fertilization time was from 2 months to 5 years. Age influenced the postoperative pregnancy rate. Other factors such as location, number and size of fibroid had no impact on fertility. Conclusion For achieving a high conception rate and guaranteeing the safety of pregnant women, a clinician should select reasonable surgical approaches, perform accurate anatomical restoration, apply strict hemostasis and choose a right time of conception.

关 键 词：子宫肌瘤 腹腔镜 子宫肌瘤剔除术 妊娠 

分 类 号：R737.33[医药卫生—肿瘤]