Bernard G, Darai E, Poncelet C, Benifla J L, Madelenat P
Service de Gynécologie-Obstétrique, Hôpital Bichat, CHU Bichat-Claude Bernard 170, Paris, France.
Eur J Obstet Gynecol Reprod Biol. 2000 Jan;88(1):85-90. doi: 10.1016/s0301-2115(99)00123-2.
The aims of this retrospective study were to evaluate the subsequent fertility and outcome of pregnancies after hysteroscopic myomectomy according to (a) the characteristics of submucous myomas and (b) the association with intramural myomas.
From July 1994 to June 1997, 119 patients had hysteroscopic myomectomy including 31 infertile women. Among these 31 patients, the mean number of removed myomas by hysteroscopy was 1.4 (range 1-4) and the mean diameter of fibroid was 20 mm (range 10 to 50).
Eleven out of 31 women (35.5%) became pregnant. Thirteen pregnancies were observed including nine term deliveries, three miscarriages and one premature labor at 24 weeks of amenorrhea. A difference in delivery rate was found between patients with one submucous myoma resected and those with two or more (p=0.02). No difference in pregnancy and in delivery rates was observed according to size and location of submucous myomas. In contrast, in patients without intramural myomas, the delivery rate (p<0.03) was significantly greater and the delay of conception (p=0.05) was significantly shorter than those found in patients with intramural myomas.
Our study suggest that fertility after hysteroscopic myomectomy depend on (a) the number of submucous myomas resected and (b) the association with intramural fibroids.
本回顾性研究的目的是根据（a）黏膜下肌瘤的特征和（b）与肌壁间肌瘤的关联，评估宫腔镜下子宫肌瘤切除术后的后续生育能力及妊娠结局。
1994年7月至1997年6月，119例患者接受了宫腔镜下子宫肌瘤切除术，其中包括31例不孕女性。在这31例患者中，宫腔镜下切除肌瘤的平均数量为1.4个（范围1 - 4个），肌瘤的平均直径为20毫米（范围10至50毫米）。
31例女性中有11例（35.5%）怀孕。观察到13次妊娠，包括9例足月分娩、3例流产和1例在闭经24周时早产。切除1个黏膜下肌瘤的患者与切除2个或更多黏膜下肌瘤的患者之间的分娩率存在差异（p = 0.02）。根据黏膜下肌瘤的大小和位置，妊娠率和分娩率未观察到差异。相比之下，在没有肌壁间肌瘤的患者中，分娩率（p < 0.03）显著更高，受孕延迟（p = 0.05）显著短于有肌壁间肌瘤的患者。
我们的研究表明，宫腔镜下子宫肌瘤切除术后的生育能力取决于（a）切除的黏膜下肌瘤数量和（b）与肌壁间肌瘤的关联。
