Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.
Department of Biostatistics, Duke University, Durham, North Carolina.
Fertil Steril. 2022 May;117(5):1083-1093. doi: 10.1016/j.fertnstert.2022.01.013. Epub 2022 Feb 23.
To assess prospectively the association between the myomectomy route and fertility.
Prospective cohort study.
The Comparing Treatments Options for Uterine Fibroids (COMPARE-UF) Study is a multisite national registry of eight clinic centers across the United States.
PATIENT(S): Reproductive-aged women undergoing surgery for symptomatic uterine fibroids.
INTERVENTION(S): Not applicable.
MAIN OUTCOME MEASURE(S): We used life-table methods to estimate cumulative probabilities and 95% confidence intervals (CI) of pregnancy and live birth by the myomectomy route during 12, 24, and 36 months of follow-up (2015-2019). We also conducted 12-month interval-based analyses that used logistic regression to estimate odds ratios and 95% CIs for associations of interest. In all analyses, we used propensity score weighting to adjust for differences across surgical routes.
RESULT(S): Among 1,095 women who underwent myomectomy (abdominal = 388, hysteroscopic = 273, and laparoscopic = 434), 202 reported pregnancy and 91 reported live birth during 36 months of follow-up. There was little difference in the 12-month probability of pregnancy or live birth by route of myomectomy overall or among women intending pregnancy. In interval-based analyses, adjusted ORs for pregnancy were 1.28 (95% CI, 0.76-2.14) for hysteroscopic myomectomy and 1.19 (95% CI, 0.76-1.85) for laparoscopic myomectomy compared with abdominal myomectomy. Among women intending pregnancy, adjusted ORs were 1.27 (95% CI, 0.72-2.23) for hysteroscopic myomectomy and 1.26 (95% CI, 0.77-2.04) for laparoscopic myomectomy compared with abdominal myomectomy. Associations were slightly stronger but less precise for live birth.
CONCLUSION(S): The probability of conception or live birth did not differ appreciably by the myomectomy route among women observed for 36 months postoperatively.
(NCT02260752, clinicaltrials.gov).
前瞻性评估子宫肌瘤剔除术的手术路径与生育能力之间的关联。
前瞻性队列研究。
“比较子宫肌瘤治疗选择（COMPARE-UF）”研究是一项多中心国家注册研究，纳入了美国 8 个临床中心的患者。
接受手术治疗有症状的子宫肌瘤的育龄期妇女。
无。
我们使用寿命表法估计了手术路径与 12、24 和 36 个月随访期间妊娠和活产的累积概率及其 95%置信区间（CI）（2015-2019 年）。我们还进行了基于 12 个月间隔的分析，使用逻辑回归估计了感兴趣的关联的比值比及其 95%CI。在所有分析中，我们使用倾向评分加权来调整手术路径之间的差异。
在 1095 例行子宫肌瘤剔除术的妇女中（经腹 388 例，经宫腔镜 273 例，腹腔镜 434 例），202 例报告在 36 个月随访期间妊娠，91 例报告活产。总体而言，或在有生育意愿的妇女中，手术路径与 12 个月妊娠或活产的概率之间几乎没有差异。在基于间隔的分析中，与经腹子宫肌瘤剔除术相比，宫腔镜子宫肌瘤剔除术的调整比值比为 1.28（95%CI，0.76-2.14），腹腔镜子宫肌瘤剔除术为 1.19（95%CI，0.76-1.85）。对于有生育意愿的妇女，宫腔镜子宫肌瘤剔除术的调整比值比为 1.27（95%CI，0.72-2.23），腹腔镜子宫肌瘤剔除术为 1.26（95%CI，0.77-2.04）。对于活产，关联结果稍强，但精度较低。
在术后 36 个月观察期间，手术路径与妊娠或活产的概率之间没有明显差异。
（NCT02260752，clinicaltrials.gov）。
