Sudik R, Hüsch K, Steller J, Daume E
Department of Gynaecology and Obstetrics, Philipps-University, Marburg, Germany.
Eur J Obstet Gynecol Reprod Biol. 1996 Apr;65(2):209-14. doi: 10.1016/0301-2115(95)02363-1.
To examine total pregnancy rate, pregnancy rate in relation to pretreatment with GnRH-analogues, the frequency of myoma recurrencies and the influence of size, number and localization of removed myomata on pregnancy rate and outcome in infertility patients after myomectomy.
A comparative, retrospective non-randomized clinical study involving 67 patients with desire for children and no other recognizable infertility factor. Myomectomy had been performed between 1985 and 1993. Most patients had been operated by laparotomy using microsurgical instruments and techniques. Thirty-three patients had been treated with a GnRH agonist for usually 3 months, and in 34 patients the operation was performed without pretreatment. Patients were followed up to June, 1994. All patients were mailed a questionnaire and invited to an ultrasound examination.
Thirty-nine of the 67 patients (58.2%) became pregnant, and a total of 51 pregnancies were observed. Of the women who actually conceived, 61.5% did so within the first year. There was no significant difference in pregnancy rates between patients who had been pretreated with GnRH agonists and those who had not. However, 1 year after the operation the group of GnRH-treated women was significantly overrepresented among those already pregnant (P = 0.02). Sonografical examination revealed in 31 out of the 67 patients (46.3%) recurrent myomata > 1 cm in diameter. There was no statistically significant difference in the pregnancy rates between patients with and without recurrencies. However, there was a significant tendency toward a loss or short duration of the pregnancy due to spontaneous abortion and premature delivery in patients with recurrent or persistent myomata (P < 0.01). Pregnancy rate was significantly lower in patients with more than five myomata removed (P < 0.001). In the group with a larger myoma volume the pregnancy rate was significantly higher than in the group with the smaller one (P < 0.01), possibly indicating that the size on removal of myomata is an important factor for infertility patients. Concerning the localization of the removed myomata, no statistically significant difference was found in the pregnancy rates between various localizations. Of the 51 pregnancies, 31 (60.8%) led to a delivery, vaginal in 13 cases (41.9%) and 18 times by Caesarean section (58.1%). Of the pregnancies that were lost, 39.2% were due to spontaneous abortion or ectopic pregnancy.
Our study supports reports on the benefits of myomectomy, performed with the appropriate technique, in patients with otherwise unknown cause of infertility. It shows, additionally, that characteristics of myomata, such as number and size, may influence postmyomectomy pregnancy rates.
研究子宫肌瘤剔除术后不孕患者的总妊娠率、与GnRH类似物预处理相关的妊娠率、肌瘤复发频率，以及所切除肌瘤的大小、数量和位置对妊娠率及妊娠结局的影响。
一项比较性、回顾性非随机临床研究，纳入67例有生育意愿且无其他可识别不孕因素的患者。子宫肌瘤剔除术于1985年至1993年间进行。大多数患者通过剖腹手术，采用显微外科器械和技术完成手术。33例患者接受GnRH激动剂治疗，通常为3个月，34例患者未进行预处理直接手术。随访至1994年6月。所有患者均收到问卷调查，并被邀请接受超声检查。
67例患者中有39例（58.2%）怀孕，共观察到51次妊娠。在实际受孕的女性中，61.5%在第一年受孕。接受GnRH激动剂预处理的患者与未接受预处理的患者妊娠率无显著差异。然而，术后1年，GnRH治疗组在已怀孕患者中的占比显著过高（P = 0.02）。超声检查显示，67例患者中有31例（46.3%）复发肌瘤直径>1 cm。有复发肌瘤和无复发肌瘤的患者妊娠率无统计学显著差异。然而，复发或持续存在肌瘤的患者因自然流产和早产导致妊娠丢失或妊娠持续时间缩短的趋势显著（P < 0.01）。切除肌瘤超过5个的患者妊娠率显著较低（P < 0.001）。肌瘤体积较大组的妊娠率显著高于体积较小组（P < 0.01），这可能表明切除肌瘤的大小对不孕患者是一个重要因素。关于所切除肌瘤的位置，不同位置的妊娠率未发现统计学显著差异。51次妊娠中，31次（60.8%）分娩，其中13例（41.9%）经阴道分娩，18例（58.1%）剖宫产。在妊娠丢失的病例中，39.2%是由于自然流产或宫外孕。
我们的研究支持了关于采用适当技术进行子宫肌瘤剔除术对其他原因不明不孕患者有益的报道。此外，研究表明肌瘤的特征，如数量和大小，可能影响子宫肌瘤剔除术后的妊娠率。
