Güler Oğuz, Hatırnaz Şafak, Sparic Radmila, Basbug Alper, Erol Onur, Kalkan Üzeyir, Ulubaşoğlu Hasan, Trojano Giuseppe, Ürkmez Sebati Sinan, Tinelli Andrea
Department of Obstetrics and Gynecology, Private Asya Hospital, Istanbul, Turkey.
Department of Obstetrics and Gynecology, Mediliv Medical Center, Samsun, Turkey.
Front Surg. 2024 Aug 1;11:1430439. doi: 10.3389/fsurg.2024.1430439. eCollection 2024.
The safety of cesarean myomectomy has been proven by previous studies. Our study aimed to reveal the long-term perinatal, obstetric, and surgical outcomes of cesarean myomectomy (CM) by comparing different CM techniques.
This retrospective multicentric case-control study involved 7 hospitals and included 226 singleton pregnancies that underwent repeated cesarean section (CS) between 2015 and 2020. Among these pregnancies, 113 of 226 cases had CM (Group A), and 113 had only CS (Group B). Of the 113 cases in which CM was performed, 58 underwent endometrial myomectomy (EM) (Subgroup A1) and 55 underwent serosal myomectomy (SM) (Subgroup A2). The groups were compared in terms of obstetric, perinatal, and surgical outcomes, and fibroid recurrence, myomectomy scar healing rate, and adhesion formation were noted.
There was no significant difference between the groups in terms of maternal age, body mass index, gravidity, parity, and fibroid diameter in previous CS ( > 0.05). In the perinatal and obstetric evaluation of the groups, there was no significant difference between the groups in terms of neonatal weight, Apgar score, fetal growth restriction, preterm premature rupture of membranes, preterm delivery, hypertension in pregnancy, and diabetes mellitus ( > 0.05). The fibroid recurrence rate was 28.3%, and the myomectomy scar good healing rate was 99.1%. There was no difference between the groups in terms of CS duration, preoperative and postoperative hemoglobin levels, perioperative blood transfusion rates, febrile morbidity, and prolonged hospitalization ( > 0.05). In terms of adhesion formation, although the adhesion rate of the SM group was higher than that of the EM group, no statistically significant difference was detected between the groups.
This study showed that in pregnancies following CM, obstetrical, perinatal, and surgical outcomes were unaffected. Obstetricians can safely use CM, either the trans-endometrial or serosal technique, as it is a safe and effective method with long-term results.
先前的研究已证实剖宫产子宫肌瘤切除术的安全性。我们的研究旨在通过比较不同的剖宫产子宫肌瘤切除术（CM）技术，揭示其围产期、产科和手术的长期结局。
这项回顾性多中心病例对照研究涉及7家医院，纳入了2015年至2020年间接受重复剖宫产（CS）的226例单胎妊娠。在这些妊娠中，226例中有113例进行了剖宫产子宫肌瘤切除术（A组），113例仅进行了剖宫产（B组）。在进行剖宫产子宫肌瘤切除术的113例病例中，58例进行了子宫内膜子宫肌瘤切除术（EM）（A1亚组），55例进行了浆膜下子宫肌瘤切除术（SM）（A2亚组）。比较各组的产科、围产期和手术结局，并记录肌瘤复发、子宫肌瘤切除术瘢痕愈合率和粘连形成情况。
各组之间在产妇年龄、体重指数、妊娠次数、产次和既往剖宫产时肌瘤直径方面无显著差异（>0.05）。在各组的围产期和产科评估中，各组之间在新生儿体重、阿氏评分、胎儿生长受限、胎膜早破、早产、妊娠期高血压和糖尿病方面无显著差异（>0.05）。肌瘤复发率为28.3%，子宫肌瘤切除术瘢痕良好愈合率为99.1%。各组在剖宫产持续时间、术前和术后血红蛋白水平、围手术期输血率、发热发病率和住院时间延长方面无差异（>0.05）。在粘连形成方面，虽然浆膜下子宫肌瘤切除术组的粘连率高于子宫内膜子宫肌瘤切除术组，但两组之间未检测到统计学上的显著差异。
本研究表明，在剖宫产子宫肌瘤切除术后的妊娠中，产科、围产期和手术结局未受影响。产科医生可以安全地使用剖宫产子宫肌瘤切除术，无论是经子宫内膜还是浆膜下技术，因为它是一种安全有效的方法，具有长期效果。
