Tinelli Andrea, Kosmas Ioannis P, Catherino William H, Carugno Jose, Mynbaev Ospan A, Sparic Radmila, Trojano Giuseppe, Malvasi Antonio
Department of Obstetrics and Gynecology, "Veris delli Ponti" Hospital, Scorrano, Lecce, Italy.
Department of Obstetrics and Gynecology, Ioannina State General Hospital G. Hatzikosta, University of Ioannina, Ioannina, Greece.
Surg J (N Y). 2021 Mar 22;7(1):e47-e53. doi: 10.1055/s-0040-1722657. eCollection 2021 Jan.
Authors evaluated the impact of laparoscopic intracapsular myomectomy (LIM) in women 40 years of age and over with desire of future fertility compared with medical management of symptomatic fibroids, by a prospective cohort study in University affiliated Hospitals. This study includes a cohort of women 40 years of age and older with symptomatic intramural fibroids with desire of future fertility. Women with symptomatic fibroid uterus were offered to undergo LIM or medical management. They were encouraged to attempt conception either spontaneously or by assisted reproductive technology (ART) according to their individual preference. All women were followed for 2 years. Fibroid characteristics, pre- and post-surgical variables, including surgical complications, days of hospitalization, pregnancy rate, and obstetrical outcomes were collected. A total of 100 patient were included in the analysis. Fifty patients were assigned to the LIM group and 50 to the medical treatment group (MT). Groups were similar regarding age (43.5 ± 2.4 and 43.5 ± 2.4, = 0.99), body mass index (23.8 ± 3.1 and 24.2 ± 3.1, = 0.54), parity (0.46 ± 0.09 and 0.58 ± 0.09, = 0.37), fibroid number (1.38 ± 0.6 and 1.46 ± 0.6, = 0.53), and fibroid size (5.92 ± 1.62 cm vs. 5.94 ± 1.49 cm, = 0.949). Of the patients who underwent LIM, 62% conceived within the study period compared with 56% in the control group ( = 0.54). Pregnancy was achieved by ART in 44% of the patients of the LIM group and 30% in control group. There was no significant difference in pregnancy rates among the two groups regarding spontaneous pregnancy rate ( = 0.332), nor in pregnancies obtained by ART with own eggs ( = 0.146) and oocyte or embryo donation ( = 0.821). The take home baby rate was 65% (20/31) in the LIM group and 61% (17/28) in the control group ( = 0.7851). Both groups had similar rate of miscarriage ( = 0.748). Patients 40 years old and over with symptomatic fibroid uterus who undergo LIM have similar subsequent fertility and obstetrical outcomes than women treated with medical management. LIM has no detrimental impact on future fertility in women 40 years old and over.
作者通过一项在大学附属医院开展的前瞻性队列研究，评估了与有症状子宫肌瘤的药物治疗相比，腹腔镜包膜内子宫肌瘤切除术（LIM）对40岁及以上有未来生育意愿女性的影响。本研究纳入了一组40岁及以上有症状肌壁间子宫肌瘤且有未来生育意愿的女性。有症状子宫肌瘤子宫的女性被提供接受LIM或药物治疗。根据个人偏好，鼓励她们自然受孕或通过辅助生殖技术（ART）受孕。所有女性均随访2年。收集肌瘤特征、手术前后变量，包括手术并发症、住院天数、妊娠率和产科结局。共有100例患者纳入分析。50例患者被分配到LIM组，50例被分配到药物治疗组（MT）。两组在年龄（43.5±2.4和43.5±2.4，P = 0.99）、体重指数（23.8±3.1和24.2±3.1，P = 0.54）、产次（0.46±0.09和0.58±0.09，P = 0.37）、肌瘤数量（1.38±0.6和1.46±0.6，P = 0.53）以及肌瘤大小（5.92±1.62cm对5.94±1.49cm，P = 0.949）方面相似。接受LIM的患者中，62%在研究期间受孕，而对照组为56%（P = 0.54）。LIM组44%的患者通过ART受孕，对照组为30%。两组在自然妊娠率（P = 0.332）、使用自身卵子通过ART受孕（P = 0.146）以及卵母细胞或胚胎捐赠受孕（P = 0.821）方面的妊娠率无显著差异。LIM组的抱婴率为65%（20/31），对照组为61%（17/28）（P = 0.7851）。两组的流产率相似（P = 0.748）。40岁及以上有症状子宫肌瘤子宫且接受LIM的患者，其后续生育能力和产科结局与接受药物治疗的女性相似。LIM对40岁及以上女性的未来生育能力没有不利影响。
