子宫肌瘤合并不孕症的治疗研究进展  

Research Progress in the Treatment of Uterine Leiomyoma Complicated with Infertility

作　　者：陆麒羽 周建维[1] LU Qiyu;ZHOU Jianwei(The Second Affiliated Hospital Zhejiang University School of Medicine,Hangzhou 310000,China;不详)

机构地区：[1]浙江大学医学院附属第二医院,浙江杭州310000 [2]浙江省宁波市妇女儿童医院

出　　处：《中国医学创新》2022年第7期168-172,共5页Medical Innovation of China

摘　　要：子宫肌瘤在育龄女性中是常见的生殖道疾病,对于合并不孕症的女性,当有明显的肌瘤相关症状时,通常建议切除肌瘤。如果为无症状的子宫肌瘤,评估其他可能导致不孕的原因。治疗方案的选择应根据患者年龄、肌瘤大小、数量、所在部位、分类采用个性化治疗,包括药物保守治疗、手术治疗以及介入治疗。黏膜下肌瘤对生育有不良影响,建议宫腔镜手术切除。浆膜下肌瘤对生育影响小,可不予处理。肌壁间肌瘤直径>4 cm、影响宫腔形态或子宫肌瘤是引起不孕的唯一因素,建议手术治疗,可选择腹腔镜子宫肌瘤切除术(laparoscopy myomectomy,LM)或开腹子宫肌瘤切除术(transabdominal myomectomy,TM);肌瘤位于子宫颈、子宫体后壁、子宫体下段可选择经阴道子宫肌瘤切除术(transvaginal myomectomy,TVM),但对术者操作技术有一定要求;子宫动脉栓塞术(uterine artery embolization,UAE)、磁共振引导聚焦超声(MR-guided focused ultrasound,MRgFUS)/高强度聚焦超声(high intensity focused ultrasound,HIFU)UAE及MRg FUS/HIFU不建议作为合并不孕症患者的首选治疗方式。Uterine fibroid is a common disease of the reproductive tract in women of childbearing age.For women with infertility,when there are obvious fibroid-related symptoms,it is usually recommended to remove fibroids.If it is asymptomatic uterine fibroids,evaluate other possible causes of infertility.The choice of treatment should be individualized according to the patient’s age,myoma size,number,location and classification,including drug conservative treatment,surgical treatment and interventional treatment.Submucosal fibroids have adverse effects on fertility,and transcervical resection is recommended.Subserosal fibroids have little effect on fertility and can be left untreated.If the diameter of Intramural myoma>4 cm,affecting the shape of uterine cavity or the uterine fibroid is the only factor causing infertility,surgical treatment was recommended,can choose laparoscopy myomectomy or transabdominal myomectomy.Leiomyoma located in the cervix,posterior and lower uterine segment can choose transvaginal myomectomy,but it is certain requirement for the operator’s operative skill.Uterine artery embolization and MR-guided focused ultrasound/high intensity focused ultrasound are not recommended as the first choice for patients with infertility.

关 键 词：子宫肌瘤 不孕 妊娠 

分 类 号：R737.33[医药卫生—肿瘤] R711.6[医药卫生—临床医学]