聚焦超声消融手术治疗子宫肌瘤妊娠结局及影响因素分析  

Analysis of pregnancy outcomes and influencing factors in patients with uterine fibroid after focused ultrasound ablation surgery

作　　者：邹敏 马容 周雯 熊郁 张炼[2] 陈文直[2] 王智彪[2] ZOU Min;MA Rong;ZHOU Wen;XIONG Yu;ZHANG Lian;CHEN Wen-zhi;WANG Zhi-biao(不详;Department of Gynecology,Chongqing Haifu Hospital,Chongqing 401121,China)

机构地区：[1]重庆海扶医院妇科,重庆401121 [2]重庆医科大学超声医学工程国家重点实验室,重庆400016

出　　处：《中国实用妇科与产科杂志》2024年第9期943-947,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：超声医学工程国家重点实验室开放课题(2023KFKT002)。

摘　　要：目的 探讨有生育需求的子宫肌瘤患者在聚焦超声消融手术(FUAS)治疗后的妊娠结局,分析影响妊娠结局的相关因素。方法 回顾性分析2011年4月至2022年12月在重庆海扶医院接受FUAS治疗的有生育需求的892例子宫肌瘤患者资料,随访术后患者的妊娠情况,并通过多因素分析探讨影响妊娠结局的因素。结果 892例患者中,排除因未婚或离异的113例患者、术后6个月内失访的82例患者,最终697例患者纳入统计。(1)在697例患者中,283例在术后6.0(3.0,10.0)个月妊娠,共计妊娠288次,术后妊娠率为40.6%(283/697)。(2)283例已妊娠的患者中,69例(24.4%)有不良孕产史,51例(18.0%)合并不孕症。(3)至随访截止(2023年10月)时,256例(261次)正常分娩,16例流产(5.6%),11例仍在孕期观察中。(4)697例中无一例孕期及产时发生子宫破裂;已分娩的患者中,14例(5.5%)出现产后并发症。(5)262例新生儿(双胎1例)中,11例出现新生儿窒息,其中1例为法洛四联征而行择期手术,其余新生儿良好。(6)妊娠组与非妊娠组比较,患者年龄、肌瘤类型、肌瘤数目、消融体积和消融率在两组间差异有统计学意义(P<0.05)。(7)正常分娩组与流产组比较,肌瘤数目、消融体积和消融率在两组间差异有统计学意义(P<0.05)。结论 FUAS治疗对有生育需求的子宫肌瘤患者是安全有效的。FUAS治疗后,患者备孕时间短,妊娠结局改善,不影响分娩方式,不增加产科风险。患者年龄大、肌瘤多发、黏膜下肌瘤、消融体积局限和消融率低,均不利于妊娠`;肌瘤数目、消融体积和消融率也是影响妊娠结局的主要因素。Objective To study the pregnancy outcomes in patients with uterine fibroids who desire future fertility after focused ultrasound ablation surgery(FUAS) and further analyze factors influencing pregnancy outcomes.Methods A total of 892 patients with uterine fibroids who desired future fertility and received FUAS treatment at Chongqing Haifu Hospital from April 2011 to December 2022 were retrospectively analyzed.Pregnancy outcomes were followed up and factors affecting pregnancy outcomes were analyzed through multivariate analysis.Results Among the 892 patients,113 patients who were unmarried or divorced,and 82 patients who were lost to follow-up within 6 months after the procedure were excluded.Finally,697 patients were enrolled.(1)Among them,283 patients were pregnant at a median of 6.0(3.0,10.0)months after FUAS,with a total of 288 pregnancies,and the post-FUAS pregnancy rate was 40.6%(283/697).(2)Among the 283 pregnant patients,69(24.4%)had a history of adverse pregnancy,and 51(18.0%) were infertile.(3) At the end of follow-up(October 2023),256 patients had 261 times of successful deliveries,11 patients were still in pregnancy,and 16 patients had miscarriage.(4) None of the 283 patients had a uterine rupture during pregnancy or delivery.Among the 256 patients who had given birth,only 14(5.5%)patients suffered from postpartum complications.(5) Of the262 newborns(1 twins),11 suffered from neonatal asphyxia,of whom 1 case of Fallot's tetralogy underwent elective surgery,while the other infants were doing well.(6) Statistical analysis showed a significant difference in age,type of fibroids,number of fibroids,non-perfused volume(NPV)and NPV ratio between the group of pregnant patients and the group of non-pregnant patients(P<0.05).(7) A significant differences in number of fibroids,NPV and NPV ratio were also observed between patients in normal delivery group and the miscarriage group(P<0.05).Conclusions FUAS is a safe and effective treatment for patients with uterine fibroids who wish to conceive.The time to concept

关 键 词：子宫肌瘤 聚焦超声消融手术 妊娠结局 影响因素 

分 类 号：R711.74[医药卫生—妇产科学]