妊娠合并子宫腺肌病患者胚胎着床部位与病灶位置的关系对妊娠结局的影响  

Effects of the relationship between adenomyotic lesions and embryo implantation site on pregnancy outcomes in pregnant patients with adenomyosis

作　　者：徐萍[1] 张亚男 尤冰冰 邹亘 张信美[1] Ping Xu;Yanan Zhang;Bingbing You;Gen Zou;Xinmei Zhang(Department of Gynecology,Women′s Hospital,School of Medicine,Zhejiang University,Hangzhou 310006,China)

机构地区：[1]浙江大学医学院附属妇产科医院妇科,杭州310006

出　　处：《中华妇产科杂志》2021年第12期856-860,共5页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨妊娠合并子宫腺肌病患者胚胎着床部位与病灶位置的关系对妊娠结局的影响。方法回顾性分析2018年1月至2020年12月因妊娠合并子宫腺肌病在浙江大学医学院附属妇产科医院住院治疗且可查到超声检查结果并能通过颈部透明层辨别胚胎或胎盘着床部位(≥孕11周)的95例患者的临床资料,复核超声检查结果,根据胚胎或胎盘着床部位与子宫腺肌病病灶位置的关系分为近距离组[指胚胎或胎盘着床部位在病灶上,或着床部位和病灶在子宫的同侧(即着床部位非常接近病灶),共59例]、远距离组(指胚胎或胎盘着床部位远离病灶,或着床部位和病灶在子宫的不同侧,共36例),进一步以妊娠28周为界将95例患者分为妊娠<28周(未能期待妊娠至28周即出现不良妊娠结局)和妊娠≥28周(妊娠至28周及以后),分析两组患者分别在这两个时间段中妊娠结局的差异。结果(1)95例妊娠合并子宫腺肌病患者的年龄为(34.8±3.5)岁。近距离组患者的年龄、孕前子宫大小以及初产妇、辅助生殖技术受孕、合并子宫内膜异位症、雌孕激素治疗史、病灶类型为弥漫性所占比例分别与远距离组比较,差异均无统计学意义(P均>0.05)。(2)95例患者中,妊娠<28周的患者12例(13%,12/95),其中近距离组11例(19%,11/59)、远距离组1例(3%,1/36),两组比较,差异有统计学意义(χ^(2)=5.100,P=0.027)。近距离组11例妊娠<28周出现不良妊娠结局的患者中,1例孕26周双胎妊娠先兆子宫破裂,5例妊娠中期胎死宫内,4例晚期难免流产,1例孕26周单胎活产;远距离组1例妊娠<28周出现不良妊娠结局的患者为晚期难免流产。(3)95例患者中,妊娠≥28周的患者83例(包括近距离组48例、远距离组35例),其最终妊娠结局均为活产。近距离组与远距离组相比,胎盘异常发生率(分别为60%、14%)、胎儿窘迫发生率(分别为27%、6%)、早产率(分别为67%、23%)、产时出血�Objective To investigate the relationship between embryo implantation site and adenomyotic lesions in pregnant patients with adenomyosis and its effects on pregnancy outcomes.Methods Between January 2018 and December 2020,the clinical data of 95 pregnant patients with adenomyosis who were hospitalized in the Women′s Hospital,School of Medicine,Zhejiang University,which could identify the implantation site of embryo or placenta(≥11 weeks of pregnancy)through the nuchal translucency test under ultrasonography were analyzed retrospectively.According to the relationship between embryo implantation site and adenomyotic lesions,95 patients were divided into two groups:short-distance group(n=59,the embryo or placenta implantation was very close to or over the adenomyotic lesion),and long-distance group(n=36,the implantation site of embryo or placenta was far away from the lesion,or the implantation site and the adenomyotic lesion were on different sides of the uterus).Next,taking 28 weeks of pregnancy as cut-off value,95 patients were divided into<28 weeks of pregnancy group(pregnancy was terminated because of adverse pregnancy outcome before 28 weeks)and≥28 weeks of pregnancy group(pregnancy lasted to 28 weeks and later),the differences of pregnancy outcomes between the two groups in different gestation times were analyzed.Results(1)The age of 95 pregnant patients with adenomyosis was(34.8±3.5)years.There were no significant differences with regard to age,uterine size before pregnancy,the proportions of primipara,assisted reproductive technology conception,endometriosis,history of estrogen and progesterone treatment,diffuse adenomyotic lesions between the short-distance group and the long-distance group(all P>0.05).(2)Among the 95 patients,12 patients(13%,12/95)had adverse pregnancy outcomes before 28 weeks of pregnancy(i.e.pregnancy<28 weeks),including 11 cases(19%,11/59)in the short-distance group and 1 case(3%,1/36)in the long-distance group,there was significant difference between the two groups(χ^(²)=5.10

关 键 词：子宫腺肌病 胚胎植入 超声检查 妊娠结局 

分 类 号：R714.2[医药卫生—妇产科学]