腹腔镜子宫肌瘤剔除术与经腹子宫肌瘤剔除术对子宫肌瘤患者术后妊娠的影响  

Influence of laparoscopic myomectomy and trans abdominal myomectomy on the postoperative pregnancy of patients with hysteromyoma

作　　者：陆宏 刘佳[2] 王晓彬[2] 李晓东[3] 

机构地区：[1]辽宁省大连市妇女儿童医疗中心,辽宁大连116001 [2]辽宁省肿瘤医院妇产科,辽宁沈阳110042 [3]大连医科大学肿瘤中心肿瘤干细胞研究院,辽宁大连116044

出　　处：《中国医药导报》2015年第12期102-106,111,共6页China Medical Herald

基　　金：辽宁省自然科学基金优秀人才培育计划项目(编号2014020105)

摘　　要：目的：比较腹腔镜子宫肌瘤剔除术与经腹子宫肌瘤剔除术对子宫肌瘤患者术后妊娠的影响。方法回顾性分析2005年1月～2010年12月于大连市妇产医院行腹腔镜子宫肌瘤剔除术或经腹子宫肌瘤剔除术的79例患者的临床资料。根据手术方式的不同，将其分为经腹手术组（43例）和腹腔镜手术组（36例）。比较两组患者的一般情况、围术期特点以及术后妊娠结局。结果术后79例患者均成功妊娠，妊娠过程中均未出现子宫破裂。两种术式均对妊娠结局均无明显影响，但子宫肌瘤的位置及盆腔粘连的程度对妊娠率有较大影响，其中，肌壁间肌瘤及黏膜下肌瘤患者的妊娠率（55.88%、42.85%）明显低于浆膜下肌瘤者（82.92%），差异均有高度统计学意义（P〈0.01）；两组患者中无盆腔粘连的患者妊娠率明显高于有盆腔粘连的患者妊娠率，差异均有统计学意义（P〈0.05）。结论无论是采用腹腔镜还是经腹手术治疗子宫肌瘤，对子宫肌瘤患者均是相对安全的，且再次妊娠过程中发生子宫破裂的可能性很小。对于有生育要求或希望保留子宫的患者，两种术式均安全、有效。Objective To compare the influence of laparoscopic myomectomy and trans abdominal myomectomyon the postoperative pregnancy outcome of the patients with uterine fibroids. Methods Clinical data of 79 patients with uterine fibroids who underwent laparoscopic myomectomy and trans abdominal myomectomy in Dalian Maternity Hospital from January 2005 to December 2010 were analyzed retrospectively. They were divided into 36 cases of laparoscopic myomectomy group and 43 cases of trans abdominal myomectomy group according the operation mode. The general situation, perioperative characteristics and pregnancy outcomes after surgery of two groups were compared. Results 79 patients were successful pregnancy, no uterine rupture cases were reported during pregnancy, and no significant effect were observed by either laparoscopic myomectomy or trans abdominal myomectomy surgery on pregnancy outcome. While the uterine fibroids location and the pelvic adhesion degree were the keys to affecting pregnancy rate of postop-erative pregnancy. Significantly lower pregnancy rate was seen in patients with intramural fibroids and submucosal fibroids （55.88%, 42.85%） than those patients with subserousmyoma （82.92%）, the differences were statistically significant （P〈0.01）. The pregnancy rate was significantly higher in patients without pelvic adhesions than those with pelvic adhesions, the difference was statistically significant （P〈0.05）. Conclusion Postoperative pregnancy after laparoscopic myomectomy and trans abdominal myomectomy are both safe, with low risk of uterine rupture. They are both effective and safe treatments for patients with fertility and uterus retention requirements.

关 键 词：子宫肌瘤 肌壁间肌瘤 黏膜下肌瘤 浆膜下肌瘤 腹腔镜 经腹子宫肌瘤剔除术 妊娠结局 

分 类 号：R711.74[医药卫生—妇产科学]