CAJ | 학술논문

目的：探讨腹腔镜下子宫肌瘤挖除术后患者妊娠结局及相关影响因素。方法回顾2009年9月至2012年12月在四川大学华西第二医院妇科行腹腔镜下子宫肌瘤挖除术并有生育要求的病例共97例。分析妊娠结局以及年龄、肌瘤大小、个数、位置等因素与术后妊娠的关系。结果患者肌瘤位置中以前壁和后壁肌瘤最为常见，分别为39．18％和38．14％，肌瘤类型中以肌壁间肌瘤最为常见（64．95％），而肌瘤数量中以单发性肌瘤最为常见（69．07％）。已妊娠者54例，妊娠率55．67％，已分娩者38例，活产率63．33％，剖宫产率78．95％。未妊娠组和妊娠组年龄构成、肌瘤大小和盆腔粘连有显著性差异（χ2值分别为11．80、9．27、4．07，均P＜0．05），但两组手术时间、术中出血量、围手术期是否贫血、有无合并症、子宫肌瘤类型、个数、位置比较均无显著性差异（χ2值分别为4．02、1．22、2．43、0．60、0．16、1．10、2．26，均P＞0．05）。盆腔粘连对术后妊娠无影响（OR＝0．40，P＝0．11），而年龄、子宫肌瘤大小是影响术后是否妊娠的重要因素（OR值分别为0．30、3．10，均P＜0．05）。＞30岁人群术后怀孕的概率是≤30岁人群的29．70％。子宫肌瘤＞5cm的人群，术后怀孕的概率是子宫肌瘤≤5cm人群的3．10倍。结论患者年龄及子宫肌瘤大小与术后妊娠有关，其他因素与术后妊娠无关。腹腔镜下子宫肌瘤挖除术是一种安全可靠的手术方式。合并较大子宫肌瘤的不孕症患者，若采取辅助生殖技术失败，应尽早行腹腔镜下子宫肌瘤挖除术，或先行手术治疗以提高辅助生殖的成功率。
목적：탐토복강경하자궁기류알제술후환자임신결국급상관영향인소。방법회고2009년9월지2012년12월재사천대학화서제이의원부과행복강경하자궁기류알제술병유생육요구적병례공97례。분석임신결국이급년령、기류대소、개수、위치등인소여술후임신적관계。결과환자기류위치중이전벽화후벽기류최위상견，분별위39．18％화38．14％，기류류형중이기벽간기류최위상견（64．95％），이기류수량중이단발성기류최위상견（69．07％）。이임신자54례，임신솔55．67％，이분면자38례，활산솔63．33％，부궁산솔78．95％。미임신조화임신조년령구성、기류대소화분강점련유현저성차이（χ2치분별위11．80、9．27、4．07，균P＜0．05），단량조수술시간、술중출혈량、위수술기시부빈혈、유무합병증、자궁기류류형、개수、위치비교균무현저성차이（χ2치분별위4．02、1．22、2．43、0．60、0．16、1．10、2．26，균P＞0．05）。분강점련대술후임신무영향（OR＝0．40，P＝0．11），이년령、자궁기류대소시영향술후시부임신적중요인소（OR치분별위0．30、3．10，균P＜0．05）。＞30세인군술후부잉적개솔시≤30세인군적29．70％。자궁기류＞5cm적인군，술후부잉적개솔시자궁기류≤5cm인군적3．10배。결론환자년령급자궁기류대소여술후임신유관，기타인소여술후임신무관。복강경하자궁기류알제술시일충안전가고적수술방식。합병교대자궁기류적불잉증환자，약채취보조생식기술실패，응진조행복강경하자궁기류알제술，혹선행수술치료이제고보조생식적성공솔。
Objective To explore the pregnancy outcomes and influencing factors of the patients undergoing laparoscopic myomectomy ( LM) .Methods From September 2009 to December 2012 totally 97 patients of uterine fibroids undergoing LM in Sichuan University West China Second Hospital with fertility requirements were selected to analyze pregnancy outcomes and their relationship with age, size, number and location of myomas.Results The most common types of myomas were anterior myomas and posterior myomas, and they occupied 39.18%and 38.14%, respectively.The most common type of leiomyoma was intramural myoma (64.95%) , and single myoma was most common (69.07%).There were 54 cases of pregnancy, and the pregnancy rate was 55.67%.Thirty-eight cases had delivered, and the live production rate and cesarean section rate was 63.33%and 78.95%, respectively.Non pregnant group was significantly different from gestational age group in age constituent, size of tumor and pelvic adhesion (χ2 value was 11.80, 9.27 and 4.07, respectively, all P<0.05), but the operation time, bleeding volume, whether anemia during perioperative period, complications, type, number and location of uterine fibroids were not significantly different (χ2 value was 4.02, 1.22, 2.43, 0.60, 0.16, 1.10 and 2.26, respectively, all P>0.05).Pelvic adhesion had no effect on postoperative pregnancy (OR=0.40,P=0.11), but age and myoma size were important factors (OR value was 0.30 and 3.10, respectively, both P<0.05).Pregnant probability of patients >30 was 29.70% of those less than 30, and that of the patients with uterine fibroids >5cm had 3.10 times of those with fibroids≤5cm.Conclusion Age and size of myomas instead of other factors have impact on postoperative pregnancy.LM is a safe and reliable surgical approach.For infertile patients with large uterine fibroids, LM should be performed when assisted reproduction technique ( ART ) is failed, or LM is needed for improving the successful rate of ART.