Mollica G, Pittini L, Minganti E, Perri G, Pansini F
Department of Biomedical Sciences, University of Ferrara, Italy.
Clin Exp Obstet Gynecol. 1996;23(3):168-72.
One hundred and six pregnant women with uterine myomas were admitted to a clinical protocol for operative or conservative management of myomas. The criteria for decision to submit to surgery were: (i) recurrent pain; (ii) large or rapidly growing myomas; (iii) large or medium myomas located in the lower uterine segment or deforming the placental site. According to these criteria 18 patients underwent myomectomy (operative group) and 88 were conservatively treated (conservative group). Complications and fetoneonatal outcome were monitored. The data were also compared to a control group of 2463 normal pregnant women. No spontaneous abortion occurred in the operated group, while the conservative group had a 13.6% spontaneous abortion rate (control group: 9.3%). The operated group had the highest cesarean section rate (93.7%), but no post-cesarean hysterectomy. The conservative group had a higher cesarean section rate compared with the pregnant women without myomas (34% vs 16.3%, respectively); they also had a 4.5% post-cesarean hysterectomy rate compared with 0.12% in the control group. Fetoneonatal outcome was good both in the conservative and operated group. The only perinatal death regarded a patient with a large myoma who refused surgery and went into premature labour at 32 weeks of gestation. Therefore, our study demonstrates that myomectomy during pregnancy is of advantage when performed early on selected patients.
106名患有子宫肌瘤的孕妇纳入了一项针对子宫肌瘤进行手术或保守治疗的临床方案。决定进行手术的标准为：（i）复发性疼痛；（ii）肌瘤大或生长迅速；（iii）位于子宫下段的大或中等肌瘤或使胎盘部位变形。根据这些标准，18例患者接受了肌瘤切除术（手术组），88例接受了保守治疗（保守治疗组）。对并发症和胎儿-新生儿结局进行了监测。数据还与2463名正常孕妇的对照组进行了比较。手术组未发生自然流产，而保守治疗组的自然流产率为13.6%（对照组：9.3%）。手术组的剖宫产率最高（93.7%），但无剖宫产术后子宫切除术。与无肌瘤的孕妇相比，保守治疗组的剖宫产率更高（分别为34%和16.3%）；与对照组的0.12%相比，其剖宫产术后子宫切除率为4.5%。保守治疗组和手术组的胎儿-新生儿结局均良好。唯一的围产期死亡病例是一名患有大肌瘤的患者，她拒绝手术，在妊娠32周时早产。因此，我们的研究表明，妊娠早期对选定患者进行肌瘤切除术是有益的。
