Keltz M, Varasteh N, Levin B, Neuwirth R
Dept Ob-Gyn, St Lukes-Roosevelt Hospital Center, Columbia College of Physicians and Surgeons, New York, New York, USA
Prim Care Update Ob Gyns. 1998 Jul 1;5(4):168. doi: 10.1016/s1068-607x(98)00068-7.
Objective: To assess the reproductive benefits of hysteroscopic myomectomy and polypectomy for infertility when compared to infertile couples with a normal cavity at hysteroscopy.Material and Methods: All patients with a diagnosis of infertility who underwent hysteroscopic evaluation by a single surgeon between 1975 and 1996 were sent a questionnaire as routine follow-up regarding their reproductive history. All 100 subjects who were located responded to the questionnaire, and 78 subjects met the inclusion criteria; age <45 years, 12 months of infertility, and 18 months of follow-up with attempts to conceive including in vitro fertilization in patients with bilateral tubal occlusion.Results: Of the 78 subjects, 36 had undergone a myomectomy, 23 a polypectomy, and 19 had a normal cavity. Among the three groups there was no significant difference in their ages, types of infertility, length of infertility, or follow-up after the procedure. Using the Cox proportional hazard model, and adjusting for age, polypectomy patients had a significantly higher pregnancy rate (RR 3.89, P <.01) and a higher live birth rate (RR 2.42, P =.06) than patients with a normal cavity. Patients who had undergone a myomectomy also had a higher pregnancy rate (RR 2.02, P =.11) and live birth rate, but this did not achieve statistical significance. Pregnancy following a hysteroscopic myomectomy was associated with a larger fibroid resection (3.15 cm vs 2.5 cm P =.05). The spontaneous abortion rate following the myomectomy, polypectomy, or a normal study was equivalent, 28.1%, 23.1%, and 29.2%, respectively.Conclusions: Both hysteroscopic polypectomy and hysteroscopic myomectomy appear to enhance fertility when compared to infertile patients with a normal cavity. Despite concern that hysteroscopic resection of a large myoma may ablate a large surface area of the endometrial cavity, patients with larger myomas were more likely to conceive following resection.
与宫腔镜检查时宫腔正常的不孕夫妇相比，评估宫腔镜子宫肌瘤切除术和息肉切除术对不孕的生殖益处。
1975年至1996年间由同一位外科医生进行宫腔镜评估的所有诊断为不孕的患者，作为常规随访被发送了一份关于其生殖史的问卷。所有找到的100名受试者回复了问卷，78名受试者符合纳入标准；年龄<45岁、不孕12个月、随访18个月且有受孕尝试，包括双侧输卵管阻塞患者的体外受精。
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名宫腔正常。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。使用Cox比例风险模型，并对年龄进行校正后，息肉切除术患者的妊娠率显著更高（相对风险3.89，P<.01），活产率也更高（相对风险2.42，P=.06），高于宫腔正常的患者。行子宫肌瘤切除术的患者妊娠率和活产率也更高，但未达到统计学显著性（相对风险2.02，P=.11）。宫腔镜子宫肌瘤切除术后的妊娠与更大的肌瘤切除相关（3.15 cm对2.5 cm，P=.05）。子宫肌瘤切除术、息肉切除术后或正常检查后的自然流产率相当，分别为28.1%、23.1%和29.2%。
与宫腔正常的不孕患者相比，宫腔镜息肉切除术和宫腔镜子宫肌瘤切除术似乎都能提高生育能力。尽管担心宫腔镜下大肌瘤切除术可能会切除子宫内膜腔的大面积，但肌瘤较大的患者切除术后更有可能受孕。
