Kroon Ben, Johnson Neil, Chapman Michael, Yazdani Anusch, Hart Roger
Queensland Fertility Group Research Foundation, Brisbane, Queensland, Australia.
Aust N Z J Obstet Gynaecol. 2011 Aug;51(4):289-95. doi: 10.1111/j.1479-828X.2011.01300.x. Epub 2011 Mar 22.
Fibroid management is surrounded by considerable controversy and uncertainty. This paper summarises the consensus developed by a group of Australasian subspecialists in reproductive endocrinology and infertility (the ACCEPT group) on the evidence concerning the impact and management of fibroids in infertility. The location of a fibroid within the uterus influences its effect on fertility. Subserosal fibroids do not appear to impact on fertility outcomes. Intramural (IM) fibroids may be associated with reduced fertility and an increased miscarriage rate (MR); however, there is insufficient evidence to inform whether myomectomy for IM fibroids improves fertility outcomes. Submucosal fibroids are associated with reduced fertility and an increased MR, and myomectomy for submucosal fibroids appears likely to improve fertility outcomes. The relative effect of multiple or different sized fibroids on fertility outcomes is uncertain, as is the relative usefulness of myomectomy in these situations. It is recommended that fibroids with suspected cavity involvement are defined by magnetic resonance imaging, sonohysterography or hysteroscopy because modalities such as transvaginal ultrasound and hysterosalpingography lack appropriate sensitivity and specificity. Medical management of fibroids delays efforts to conceive and is not recommended for the management of infertility associated with fibroids. Newer treatments such as uterine artery embolisation, radiofrequency ablation, bilateral uterine artery ligation, magnetic resonance-guided focussed ultrasound surgery and fibroid myolysis require further investigation prior to their establishment in the routine management of fibroid-associated infertility.
子宫肌瘤的管理存在相当大的争议和不确定性。本文总结了一组澳大利亚生殖内分泌学和不孕症亚专科医生（ACCEPT小组）就子宫肌瘤对不孕症的影响及管理方面的证据达成的共识。子宫肌瘤在子宫内的位置会影响其对生育能力的作用。浆膜下肌瘤似乎不会影响生育结局。肌壁间（IM）肌瘤可能与生育能力下降和流产率（MR）增加有关；然而，尚无足够证据表明针对IM肌瘤进行肌瘤切除术能否改善生育结局。黏膜下肌瘤与生育能力下降和MR增加有关，针对黏膜下肌瘤进行肌瘤切除术似乎有可能改善生育结局。多个或不同大小的肌瘤对生育结局的相对影响尚不确定，肌瘤切除术在这些情况下的相对效用也不确定。建议通过磁共振成像、宫腔超声造影或宫腔镜检查来确定疑似累及宫腔的肌瘤，因为经阴道超声和子宫输卵管造影等检查方法缺乏足够的敏感性和特异性。子宫肌瘤的药物治疗会延迟受孕努力，不建议用于治疗与子宫肌瘤相关的不孕症。诸如子宫动脉栓塞术、射频消融术、双侧子宫动脉结扎术、磁共振引导聚焦超声手术和肌瘤溶解术等新型治疗方法，在确立用于常规管理与子宫肌瘤相关的不孕症之前，需要进一步研究。
