Seinera P, Farina C, Todros T
Department of Obstetrics and Gynecology, S.Anna Hospital, Turin, Italy.
Hum Reprod. 2000 Sep;15(9):1993-6. doi: 10.1093/humrep/15.9.1993.
The laparoscopic approach to myomectomy has raised questions about the risk of uterine rupture in patients who become pregnant following surgery. It has been suggested that the rupture outside labour in pregnancies following laparoscopic myomectomy can be due to the difficulty of suturing or to the presence of a haematoma or to the wide use of radio frequencies. In this paper we describe the pregnancy outcome of 54 patients submitted to laparoscopic myomectomy at our Institution and prospectively followed during subsequent pregnancies. A total of 202 patients underwent laparoscopic myomectomy. A total of 65 pregnancies occurred in 54 patients who became pregnant following surgery. Data were collected about complications of pregnancy, mode of delivery, gestational age at delivery and birthweight of the neonates. No cases of uterine rupture occurred. Twenty-one pregnancies followed an IVF procedure. Nine patients conceived twice and one three times. Four multiple pregnancies occurred. Eight pregnancies resulted in a first trimester miscarriage and another in an interstitial pregnancy requiring laparotomic removal of the cornual gestational sac. Of the remaining 56 pregnancies, 51 (91%) were uneventful. In two cases a cerclage was performed at 16 weeks. In two cases pregnancy-induced hypertension developed. Two pregnancies ended with a preterm labour (26-36 weeks). A Caesarean section was performed in 45 cases (54/57, 80%). In terms of the safety of laparoscopic myomectomy in patients who become pregnant following surgery, our results were encouraging. However, further studies are needed to provide reliable data on the risk factors and the true incidence of uterine rupture.
对于接受肌瘤剔除术的患者，腹腔镜手术方式引发了人们对术后妊娠子宫破裂风险的质疑。有人提出，腹腔镜肌瘤剔除术后妊娠时非分娩期子宫破裂可能是由于缝合困难、存在血肿或广泛使用射频所致。在本文中，我们描述了我院54例接受腹腔镜肌瘤剔除术且在随后妊娠期间接受前瞻性随访的患者的妊娠结局。共有202例患者接受了腹腔镜肌瘤剔除术。54例术后妊娠的患者共发生65次妊娠。收集了妊娠并发症、分娩方式、分娩时孕周及新生儿出生体重的数据。未发生子宫破裂病例。21次妊娠是通过体外受精（IVF） procedure进行的。9例患者受孕两次，1例受孕三次。发生4例多胎妊娠。8次妊娠导致孕早期流产，另1次为间质部妊娠，需开腹切除宫角妊娠囊。其余56次妊娠中，51次（91%）情况良好。2例在孕16周时进行了宫颈环扎术。2例发生了妊娠期高血压。2次妊娠以早产（26 - 36周）结束。45例（54/57，80%）进行了剖宫产。就腹腔镜肌瘤剔除术对术后妊娠患者的安全性而言，我们的结果令人鼓舞。然而，需要进一步研究以提供关于子宫破裂危险因素和真实发生率的可靠数据。
