Zhou Yong, Shen Li, Wang Yuan, Yang Mengjia, Chen Zhengyun, Zhang Xinmei
Women's Hospital, Zhejiang University School of Medicine, No.1 Xueshi Road, Hangzhou 310006, China.
J Clin Med. 2022 Jun 17;11(12):3489. doi: 10.3390/jcm11123489.
Although many studies show that patients with diffuse adenomyosis who underwent fertility-sparing surgery can have a successful pregnancy, their pregnancy outcomes are still controversial. The objective of this study was to determine long-term pregnancy outcomes and possible influencing factors after double-flap adenomyomectomy for patients with diffuse adenomyosis. A total of 137 patients with diffuse adenomyosis who underwent double-flap adenomyomectomy between January 2011 and December 2019 were studied, and correlations between pregnancy outcomes and clinical data, including age and junctional zone measured by magnetic resonance imaging (JZmax-A), were analyzed. The results show that 56 patients (40.9%, 56/137) had 62 pregnancies, including 35 natural pregnancies and 27 assisted reproduction pregnancies, after operation. A univariate regression analysis showed that the pregnancy outcomes were related to age at surgery, visual analog scale (VAS) score of preoperative dysmenorrhea, parity experience, length of infertility, and postoperative JZmax-A. A multivariate regression analysis showed that age at surgery, VAS score of preoperative dysmenorrhea, and postoperative JZmax-A were the independent indicators correlated with pregnancy outcomes. A receiver operating characteristic curve analysis showed that postoperative JZmax-A was the most valuable indicator for predicting pregnancy outcomes. Cumulative pregnancy rates during the first 3 years were 70.1% and 20.9% in the postoperative JZmax-A ≤ 8.5 mm and the postoperative JZmax-A > 8.5 mm groups, respectively. In conclusion, double-flap adenomyomectomy could improve fertility for diffuse adenomyosis, and postoperative JZmax-A might be a promising indicator for predicting pregnancy outcomes.
尽管许多研究表明，接受保留生育功能手术的弥漫性子宫腺肌病患者能够成功妊娠，但其妊娠结局仍存在争议。本研究的目的是确定弥漫性子宫腺肌病患者行双瓣子宫腺肌瘤切除术后的长期妊娠结局及可能的影响因素。对2011年1月至2019年12月期间行双瓣子宫腺肌瘤切除术的137例弥漫性子宫腺肌病患者进行研究，并分析妊娠结局与临床资料（包括年龄和磁共振成像测量的结合带（JZmax-A））之间的相关性。结果显示，术后56例患者（40.9%，56/137）妊娠62次，其中自然妊娠35次，辅助生殖妊娠27次。单因素回归分析显示，妊娠结局与手术年龄、术前痛经视觉模拟评分（VAS）、产次、不孕时间及术后JZmax-A有关。多因素回归分析显示，手术年龄、术前痛经VAS评分及术后JZmax-A是与妊娠结局相关的独立指标。受试者工作特征曲线分析显示，术后JZmax-A是预测妊娠结局最有价值的指标。术后JZmax-A≤8.5 mm组和术后JZmax-A>8.5 mm组前3年的累积妊娠率分别为70.1%和20.9%。综上所述，双瓣子宫腺肌瘤切除术可改善弥漫性子宫腺肌病患者的生育能力，术后JZmax-A可能是预测妊娠结局的一个有前景的指标。
