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剖宫产史是子宫肌瘤患者异常子宫出血的危险因素吗？

Is a history of cesarean section a risk factor for abnormal uterine bleeding in patients with uterine leiomyoma?

作者信息

Kinay Tugba, Basarir Zehra O, Tuncer Serap F, Akpinar Funda, Kayikcioglu Fulya, Koc Sevgi, Karakaya Jale

机构信息

Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey. E-mail.

出版信息

Saudi Med J. 2016 Aug;37(8):871-6. doi: 10.15537/smj.2016.8.14711.

DOI:10.15537/smj.2016.8.14711
PMID:27464864
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5018704/
Abstract

OBJECTIVES

To determine whether a history of cesarean section was a risk factor for abnormal uterine bleeding in patients with uterine leiomyomas, and to identify other risk factors for this symptom.

METHODS

We analyzed retrospectively, the medical records of patients who underwent hysterectomies due to the presence of uterine leiomyomas during a 6-year period (2009 and 2014) at Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey. Uterine leiomyoma was diagnosed based on histopathological examination of hysterectomy specimens. Demographic characteristics, and laboratory and histopathological findings were compared between patients with uterine leiomyoma with and without abnormal uterine bleeding.

RESULTS

In total, 501 (57.9%) patients had abnormal uterine bleeding and 364 (42.1%) patients had other symptoms. A history of cesarean section was more common in patients with abnormal uterine bleeding than in those with other symptoms (17.6% versus 9.3%, p=0.001; odds ratio [OR]: 2.1; 95% confidence interval [CI]: 1.4-3.3). The presence of a submucosal leiomyoma (OR: 2.1; 95% CI: 1.5-3.1) and coexistent adenomyosis (OR: 1.6; 95% CI: 1.1-2.4) were also associated with abnormal uterine bleeding.

CONCLUSION

A history of cesarean section was an independent risk factor for abnormal uterine bleeding in patients with uterine leiomyomas; submucosal leiomyoma and coexisting adenomyosis were also independent risk factors.

摘要

目的

确定剖宫产史是否为子宫肌瘤患者异常子宫出血的危险因素，并识别该症状的其他危险因素。

方法

我们回顾性分析了2009年至2014年期间在土耳其安卡拉埃特利克祖贝德哈尼姆妇女健康培训与研究医院因子宫肌瘤接受子宫切除术的患者的病历。根据子宫切除标本的组织病理学检查诊断子宫肌瘤。比较了有和没有异常子宫出血的子宫肌瘤患者的人口统计学特征、实验室检查和组织病理学检查结果。

结果

总共501例（57.9%）患者有异常子宫出血，364例（42.1%）患者有其他症状。有剖宫产史的异常子宫出血患者比有其他症状的患者更常见（17.6%对9.3%，p=0.001；比值比[OR]：2.1；95%置信区间[CI]：1.4-3.3）。黏膜下肌瘤（OR：2.1；95%CI：1.5-3.1）和并存的子宫腺肌病（OR：1.6；95%CI：1.1-2.4）也与异常子宫出血相关。

结论

剖宫产史是子宫肌瘤患者异常子宫出血的独立危险因素；黏膜下肌瘤和并存的子宫腺肌病也是独立危险因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bb80/5018704/ac2daf4fa909/SaudiMedJ-37-871-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bb80/5018704/ac2daf4fa909/SaudiMedJ-37-871-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bb80/5018704/ac2daf4fa909/SaudiMedJ-37-871-g001.jpg

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本文引用的文献

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What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies.在人群层面，剖宫产的最佳比率是多少？生态学研究的系统评价。
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Clinical management of leiomyoma.平滑肌瘤的临床管理
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Higher cesarean delivery rates are associated with higher infant mortality rates in industrialized countries.在工业化国家，较高的剖宫产率与较高的婴儿死亡率相关。
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Fibroid growth and medical options for treatment.子宫肌瘤的生长和治疗的医学选择。
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Management of leiomyomas in perimenopausal women.围绝经期女性平滑肌瘤的管理
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Long-term complications of caesarean section. The niche in the scar: a prospective cohort study on niche prevalence and its relation to abnormal uterine bleeding.剖宫产术后的长期并发症。瘢痕内陷：一项关于瘢痕内陷发生率及其与异常子宫出血关系的前瞻性队列研究。
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Do cesarean deliveries on maternal request lead to greater maternal care utilization during six-month, one-year, and two-year postpartum periods? Evidence from NHI claims data in Taiwan.应产妇要求进行剖宫产在产后六个月、一年和两年期间会导致产妇更多地利用医疗服务吗？来自台湾全民健康保险索赔数据的证据。
Health Policy. 2014 Jul;117(1):39-47. doi: 10.1016/j.healthpol.2013.10.003. Epub 2013 Oct 22.
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Uterine fibroids.子宫肌瘤
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Cesarean scar defects: an underrecognized cause of abnormal uterine bleeding and other gynecologic complications.剖宫产术后子宫瘢痕缺陷：异常子宫出血和其他妇科并发症的一个被低估的原因。
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