Gynecology and Obstetrics Unit, IRCCS San Raffaele Institute, 20132 Milan, Italy.
Gynecology and Obstetrics Unit, IRCCS San Raffaele Institute, 20132 Milan, Italy.
Eur J Obstet Gynecol Reprod Biol. 2024 Oct;301:194-200. doi: 10.1016/j.ejogrb.2024.08.024. Epub 2024 Aug 13.
To explore the utility of the total fibroids-to-uterine volume (FTUV) ratio as a simple, preoperative tool to assist in counseling patients seeking pregnancy who are undergoing myomectomy for intramural (IM) fibroids.
This is an historical cohort study on reproductive-aged patients seeking pregnancy who underwent laparotomic myomectomy for intramural fibroids from January 2017 to December 2021. Only G3 to G5 fibroids, according to the 2011 International Federation of Gynecology and Obstetrics (FIGO) classification, were included. Pre-operative transvaginal ultrasound (TVUS) was performed to measure the volume of intramural myomas (diameterdiameterdiameter*0.52) and to calculate their total volume. The total fibroids-to-uterine volume (FTUV) ratio was calculated as the proportion of the uterine volume occupied by the sum of IM fibroids volumes.
A total of 166 women with pre-surgical TVUS evaluation of IM fibroids were included, with a mean age of 36.22 ± 5.15 years. The FTUV ratio was identified as a positive predictor of clinical pregnancy after surgery (adjOR, 1.04; 95 % CI, 1.02-1.06; p = 0.0001), whereas age showed a negative association (adjOR, 0.90; 95 % CI, 0.83-0.98; p = 0.012). Endometrial cavity distortion prior to surgery was also positively associated with pregnancy post-surgery (adjOR, 3.50; 95 % CI, 1.51-8.08; p = 0.003). Consistent results were found for live births, with the FTUV ratio being a significant positive predictor of live birth after surgery (adjOR, 1.03; 95 % CI, 1.01-1.05; p = 0.001) and age showing a negative association (adjOR, 0.88; 95 % CI, 0.80-0.96; p = 0.004). Parity prior to surgery also positively impacted live birth post-surgery (adjOR, 2.65; 95 % CI, 1.30-5.40; p = 0.007). An FTUV ratio threshold of 53.39 % accurately predicted clinical pregnancy in 68.46 % of cases (sensitivity of 71.70 % and specificity of 66.67 %). For live births, a higher FTUV ratio threshold of 59.21 % predicted outcomes accurately in 69.13 % of cases (sensitivity of 65.85 % and specificity of 70.37 %).
The use of the FTUV ratio in pre-operative ultrasound evaluation of IM fibroids may improve counseling for patients desiring to conceive after myomectomy. By providing a personalized assessment of the amount of myometrial volume occupied by fibroids, the FTUV ratio can help predict fertility outcomes after surgery, enabling better-informed decisions and treatment planning.
探讨总肌瘤-子宫体积（FTUV）比值作为一种简单的术前工具，用于辅助因子宫壁（IM）肌瘤而行肌瘤切除术的妊娠患者的咨询。
这是一项对 2017 年 1 月至 2021 年 12 月期间因 IM 肌瘤而行剖腹肌瘤切除术的有生育能力的患者进行的历史队列研究。仅包括 2011 年国际妇产科联合会（FIGO）分类中的 G3 至 G5 肌瘤。术前进行经阴道超声（TVUS）检查，以测量子宫壁肌瘤的体积（直径×直径×直径×0.52）并计算其总体积。总肌瘤-子宫体积（FTUV）比值的计算方法是将 IM 肌瘤体积之和占子宫体积的比例。
共纳入了 166 例术前接受 TVUS 评估的 IM 肌瘤患者，平均年龄为 36.22±5.15 岁。FTUV 比值被确定为手术后临床妊娠的阳性预测因子（调整优势比，1.04；95%置信区间，1.02-1.06；p=0.0001），而年龄呈负相关（调整优势比，0.90；95%置信区间，0.83-0.98；p=0.012）。术前子宫内膜腔变形也与术后妊娠呈正相关（调整优势比，3.50；95%置信区间，1.51-8.08；p=0.003）。对于活产，也有一致的结果，FTUV 比值是手术后活产的显著阳性预测因子（调整优势比，1.03；95%置信区间，1.01-1.05；p=0.001），年龄呈负相关（调整优势比，0.88；95%置信区间，0.80-0.96；p=0.004）。手术前的孕次也对手术后的活产有积极影响（调整优势比，2.65；95%置信区间，1.30-5.40；p=0.007）。FTUV 比值为 53.39%的阈值可准确预测 68.46%的临床妊娠（敏感性为 71.70%，特异性为 66.67%）。对于活产，FTUV 比值为 59.21%的更高阈值可准确预测 69.13%的结果（敏感性为 65.85%，特异性为 70.37%）。
在 IM 肌瘤的术前超声评估中使用 FTUV 比值可以改善肌瘤切除术后希望妊娠的患者的咨询。通过对肌瘤占据的子宫肌体积进行个性化评估，FTUV 比值可以帮助预测手术后的生育结局，从而做出更明智的决策和治疗计划。
