Department of Obstetrics and Gynecology and CERICSAL (Centro di RIcerca Clinico Salentino), "Veris Delli Ponti Hospital", Scorrano, Via Giuseppina Delli Ponti, 73020, Lecce, Italy.
Department of Obstetrics and Gynecology, Ioannina State General Hospital G. Chatzikosta, Ioannina, Greece.
Arch Gynecol Obstet. 2023 Oct;308(4):1351-1360. doi: 10.1007/s00404-023-07135-0. Epub 2023 Jul 14.
To study whether it is better to perform or not a myomectomy, in terms of surgical and reproductive outcomes in patients of advanced reproductive age, by an observational prospective study in university-affiliated and Community Hospitals.
40 years and older patients affected by non-submucous symptomatic uterine fibroids and desiring future fertility were enrolled and treated by laparoscopic intracapsular myomectomy by (LIM) or by open laparotomy (OIM), or by a non-surgical management as control group, while attempting to conceive. The primary outcome measures were fibroid characteristics, pre- and post-surgical parameters, pregnancy achievement; the secondary outcome measures were the spontaneous or ART pregnancy outcomes, eventual week of abortion and type of delivery. Propensity scores have been calculated with logistic regression for binary and continuous variables.
202 patients completed the study: 112 operated by LIM, 40 by OIM and 50 patients as control group. Patients undergoing OIM have a worse surgical outcome than LIM. No difference was seen in pregnancy either after myomectomy or control group during follow-up. In the LIM group, there were 44 pregnancies (39.2%), and in the OIM group, there were 9 (22.5%) and 16 in the control group (32%). The weeks of delivery were statistically greater for the control group versus the surgical groups, with no difference in Apgar score between the 3 groups.
Patients aged over 40 years did not show substantial differences in reproductive outcome, whether operated or not. Myomectomy in over 40-year-old patients has no detrimental effect on future pregnancy rates and over when compared to expectant management.
通过在大学附属和社区医院进行观察性前瞻性研究，研究在高龄患者中，进行或不进行子宫肌瘤切除术在手术和生殖结局方面是否更好。
纳入年龄在 40 岁及以上、患有非黏膜下有症状的子宫肌瘤且希望未来生育的患者，并通过腹腔镜囊内子宫肌瘤切除术（LIM）或剖腹手术（OIM）或非手术治疗作为对照组进行治疗，同时尝试怀孕。主要结局指标为肌瘤特征、术前和术后参数、妊娠结局；次要结局指标为自然或 ART 妊娠结局、最终流产周数和分娩类型。采用逻辑回归计算二分类和连续变量的倾向评分。
202 例患者完成了研究：112 例行 LIM，40 例行 OIM，50 例为对照组。行 OIM 的患者手术结局较 LIM 差。在随访期间，无论是否进行子宫肌瘤切除术，行 OIM 的患者的妊娠结局均与对照组无差异。在 LIM 组中，有 44 例妊娠（39.2%），在 OIM 组中，有 9 例（22.5%）和 16 例在对照组（32%）。与手术组相比，对照组的分娩周数统计学上更大，但 3 组之间的阿普加评分无差异。
40 岁以上的患者无论是否接受手术，在生殖结局方面没有明显差异。对于 40 岁以上的患者，子宫肌瘤切除术对未来妊娠率没有不良影响，与期待治疗相比，妊娠率更高。
