Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.
Eur J Obstet Gynecol Reprod Biol. 2012 Apr;161(2):130-3. doi: 10.1016/j.ejogrb.2011.12.009. Epub 2012 Feb 17.
To examine long-term effects of transvaginal myomectomy by colpotomy on uterine ruptures, fertility and pregnancy outcome.
Transvaginal myomectomy by colpotomy was performed for sixteen patients who had symptomatic uterine leiomyomas and wished to preserve their fertility. Data on possible pregnancies, infertility treatments, hysterectomies and other reoperations during a follow-up period of ten years were retrospectively collected from the hospital records. Those who had no outpatient contacts in the hospital records were interviewed by telephone.
Eight (50%) of the 16 patients tried actively to conceive and they produced 14 pregnancies: six of them had two pregnancies and two had one. The median interval between the transvaginal myomectomy and the first pregnancy was 17 months (range 14-68 months). All pregnancies were uneventful and ended in full-term delivery of a healthy infant. Uncomplicated vaginal delivery was recorded in 10 (71%), vacuum extraction in one (7%) and cesarean section in three (21%) out of 14 cases. Uterine rupture or heavy postpartal bleeding was not reported.
Pregnancies after transvaginal myomectomy by colpotomy were uneventful and no uterine ruptures were detected during a long-term follow-up. Pregnancy rates after the procedure appear to be similar to results after abdominal or laparoscopic myomectomy. Transvaginal myomectomy by colpotomy is a safe and feasible treatment option for selected patients wishing to preserve their ability to conceive.
探讨经阴道子宫切开术治疗子宫肌瘤对子宫破裂、生育能力和妊娠结局的长期影响。
对 16 例有症状的子宫肌瘤且希望保留生育能力的患者进行经阴道子宫切开术治疗。从医院病历中回顾性收集了 10 年随访期间可能发生的妊娠、不孕治疗、子宫切除术和其他再次手术的数据。对于医院病历中无门诊接触的患者，通过电话进行了访谈。
16 例患者中有 8 例（50%）积极尝试怀孕，她们共生育了 14 胎：其中 6 例怀了 2 胎，2 例怀了 1 胎。经阴道子宫肌瘤切除术至首次妊娠的中位间隔为 17 个月（范围 14-68 个月）。所有妊娠均无并发症，足月分娩健康婴儿。14 例中有 10 例（71%）阴道分娩顺利，1 例（7%）采用真空抽吸，3 例（21%）采用剖宫产。未报告子宫破裂或产后大出血。
经阴道子宫切开术治疗后的妊娠无并发症，长期随访未发现子宫破裂。该手术的妊娠率似乎与腹式或腹腔镜子宫肌瘤切除术的结果相似。经阴道子宫切开术治疗是希望保留生育能力的特定患者的一种安全可行的治疗选择。
