Varasteh N N, Neuwirth R S, Levin B, Keltz M D
Department of Obstetrics & Gynecology, St. Luke's-Roosevelt Hospital Center, University Hospital of Columbia University, College of Physicians & Surgeons, New York, New York 10019, USA.
Obstet Gynecol. 1999 Aug;94(2):168-71. doi: 10.1016/s0029-7844(99)00278-1.
To compare reproductive benefits of hysteroscopic myomectomy and polypectomy for infertility to outcomes in infertile couples with normal hysteroscopic findings.
Women with diagnoses of infertility who had hysteroscopic evaluations by a single surgeon between 1975 and 1996 were sent a routine follow-up questionnaire regarding their reproductive histories. All 92 subjects who were located responded to the questionnaire, and 78 met inclusion criteria: age under 45 years, at least 12 months of infertility, and at least 18 months of follow-up with attempts to conceive, including in vitro fertilization in women with bilateral tubal occlusion.
Of the 78 subjects, 36 had myomectomies, 23 had polypectomies, and 19 had normal cavities. Among the three groups, there were no significant differences in age, type of infertility, length of infertility, or follow-up after the procedure. Polypectomy subjects had significantly higher pregnancy and live birth rates than women with normal cavities. Women who had myomectomies larger than 2 cm had significantly higher pregnancy and live birth rates, achieving statistical significance at a myoma size of 3 cm or greater for live births. Spontaneous abortion rates among first pregnancies after myomectomy, polypectomy, or normal study were similar: 31.5%, 27.7%, and 37.5%, respectively.
Both hysteroscopic polypectomy and hysteroscopic myomectomy appeared to enhance fertility compared with infertile women with normal cavities. Despite concern that hysteroscopic resection of a large myoma might ablate a large surface area of the endometrial cavity, the reproductive benefit appears greater than the risk.
比较宫腔镜下子宫肌瘤切除术和息肉切除术对不孕症患者的生殖益处与宫腔镜检查结果正常的不孕夫妇的结局。
1975年至1996年间由同一外科医生进行宫腔镜评估的不孕症女性收到了一份关于其生殖史的常规随访问卷。找到的所有92名受试者均对问卷做出了回应，其中78名符合纳入标准：年龄在45岁以下、不孕至少12个月、尝试受孕并随访至少18个月，包括双侧输卵管阻塞女性的体外受精。
78名受试者中，36例行子宫肌瘤切除术，23例行息肉切除术，19例宫腔正常。三组在年龄、不孕类型、不孕时间或手术后随访方面无显著差异。息肉切除术组的妊娠率和活产率显著高于宫腔正常的女性。肌瘤大于2 cm的子宫肌瘤切除术女性的妊娠率和活产率显著更高，肌瘤大小为3 cm或更大时活产率具有统计学意义。子宫肌瘤切除术、息肉切除术或正常检查后首次妊娠的自然流产率相似：分别为31.5%、27.7%和37.5%。
与宫腔正常的不孕女性相比，宫腔镜下息肉切除术和子宫肌瘤切除术似乎都能提高生育能力。尽管担心宫腔镜下切除大肌瘤可能会切除子宫内膜腔的大面积，但生殖益处似乎大于风险。
