腹腔镜与宫腔镜手术剔除子宫壁间肌瘤对患者妊娠结局影响及术后残留复发因素分析  

The influence of laparoscopic and hysteroscopic surgery to remove uterine intermural fibroids of patients on their later pregnancy outcomes and the analysis of related factors of residual fibroids recurrence after surgery

作　　者：陈晓娟 王洁 李晶 季新梅 CHEN Xiaojuan;WANG Jie;LI Jing;JI Xinmei(Shenzhen Longhua People's Hospital,Guangdong Province,518109)

机构地区：[1]深圳市龙华区人民医院,518109

出　　处：《中国计划生育学杂志》2022年第3期691-694,698,共5页Chinese Journal of Family Planning

摘　　要：目的:探讨腹腔镜与宫腔镜手术剔除子宫壁间肌瘤对患者妊娠结局的影响及术后残留复发相关因素。方法:回顾性分析2015年1月-2020年1月本院收治的150例子宫壁间肌瘤患者临床资料,根据手术方式分为腹腔镜组(82例)和宫腔镜组(68例),比较两组妊娠结局,术后随访12个月获取患者残余复发情况,采用多因素logistic回归分析术后残余复发相关因素。结果;两组术后妊娠率、妊娠丢失率、足月剖宫产率、因肌瘤剔除史行剖宫产率等均无差异(均P>0.05),宫腔镜组妊娠距手术时间短于腹腔镜组(P<0.05),术后残留复发率腹腔镜组(25.6%)与宫腔镜组(29.4%)无差异(P>0.05)。多因素分析显示,年龄≥40岁为术后残留复发的独立保护因素[OR=0.406,95%CI(0.166~0.994)],未绝经[OR=3.356,95%CI(1.275~8.830)]、肌瘤直径≥4cm[OR=4.430,95%CI(1.787~10.983)]、术后未药物治疗[OR=2.811,95%CI(1.180~6.699)]等为术后残留复发的独立危险因素。结论:子宫壁间肌瘤腹腔镜与宫腔镜手术剔除治疗后妊娠结局类似,而患者年龄、绝经状态、肌瘤直径、术后药物治疗情况等为术后残留复发的相关影响因素。提示临床采取相应干预措施以降低术后残留复发风险。Objective: To explore the influence of laparoscopic and hysteroscopic surgery to remove uterine intermural fibroids of patients on their later pregnancy outcomes, and to analyze the related factors of residual fibroids recurrence after surgery. Methods: The clinical data of 150 patients with uterine intermural fibroids from January 2015 to January 2020 were analyzed retrospectively. These patients were divided into group A(82 cases with laparoscopic surgery) and group B(68 cases with hysteroscopy surgery) according to different surgical method. The pregnancy outcomes of the patients were compared between the two groups. The situation of residual fibroids recurrence after surgery was obtained after followed up for post operative 12 months. Multivariate Logistic regression analysis was used to analyze the factors related to residual fibroids recurrence after surgery. Results: There were no significant differences in the postoperative pregnancy rate, the pregnancy loss rate, the full-term cesarean section rate, and the rate of cesarean section due to myomectomy history of the patients between the two groups(all P>0.05). The time from remove uterine intermural fibroids to pregnancy of the patients in group B was significantly shorter than that of the patients in group A(P<0.05). There was no significant different in postoperative residual fibroids recurrence rate(25.6% vs. 29.4%) of the patients between the two groups(P>0.05). Multivariate analysis had showed that age ≥40 years old was an independent protective factor of postoperative fibroids residual recurrence(OR=0.406, 95%CI 0.166-0.994). Premenopausal(OR=3.356, 95%CI 1.275-8.830), fibroid diameter ≥4 cm(OR=4.430, 95%CI 1.787-10.983), and without postoperative drug therapy(OR=2.811, 95%CI 1.180-6.699) were the independent risk factors of postoperative fibroids residual recurrence. Conclusion: Laparoscopic and hysteroscopic surgery to remove uterine intermural of patients have similar later pregnancy outcomes.The related factors of residual fibroids recurrence

关 键 词：子宫壁间肌瘤 腹腔镜 宫腔镜 术后残留复发 妊娠结局 影响因素 

分 类 号：R737.33[医药卫生—肿瘤]