Guillaume A J, Benjamin F, Spitzer M
Department of Obstetrics and Gynecology, Catholic Medical Center of Brooklyn and Queens, New York, New York, USA.
J Reprod Med. 1998 Jun;43(6):483-6.
To determine whether women who require tuboplasty for infertility and have associated uterine leiomyomas that require removal should have the myomectomy done concurrently.
Eighty-nine infertility patients underwent tuboplasty alone for proximal tubal obstruction, 30 others were treated by both myomectomy and tuboplasty during the same operation, and 15 others underwent tuboplasty, leaving the myomas in situ. The tuboplasty in all cases consisted of tubal resection and anastomosis (TRA). The pregnancy rates and outcomes in the three groups were compared.
Of the 89 patients who underwent TRA alone, 74.2% (66 patients) became pregnant, and of those 66, 15.2% had a spontaneous miscarriage, 24.2% developed an ectopic pregnancy, and 60.6% achieved a viable birth. By comparison, of 30 patients who had both TRA and myomectomy, 63.6% (19 patients) conceived, and of those 19, 15.8% miscarried, 26.3% developed ectopic pregnancies, and 57.9% achieved viable births. Of 15 patients who underwent TRA leaving the myomas in situ, 73% (11) became pregnant, and of those 11, 45% (5) miscarried, 18% (2) had ectopic pregnancies and 36% (4) gave birth to viable infants. The incidence of pregnancies, ectopic gestations, miscarriages and viable births in the three groups showed no statistical differences.
When myomectomy is indicated, because of the lack of disadvantages of performing it at the time of tuboplasty, the combined surgical approach should be the procedure of choice rather than leaving the myomas in situ for their removal in a separate operation at a later date.
确定因不孕症需要进行输卵管成形术且伴有需要切除的子宫平滑肌瘤的女性是否应同时进行肌瘤切除术。
89例不孕症患者因近端输卵管阻塞单独接受输卵管成形术，另外30例在同一手术中同时接受肌瘤切除术和输卵管成形术，还有15例接受输卵管成形术，肌瘤保留原位。所有病例的输卵管成形术均包括输卵管切除和吻合术（TRA）。比较三组的妊娠率和结局。
仅接受TRA的89例患者中，74.2%（66例）怀孕，在这66例中，15.2%发生自然流产，24.2%发生异位妊娠，60.6%成功分娩。相比之下，同时接受TRA和肌瘤切除术的30例患者中，63.6%（19例）受孕，在这19例中，15.8%流产，26.3%发生异位妊娠，57.9%成功分娩。接受TRA且肌瘤保留原位的15例患者中，73%（11例）怀孕，在这11例中，45%（5例）流产，18%（2例）发生异位妊娠，36%（4例）产下活婴。三组的妊娠、异位妊娠、流产和活产发生率无统计学差异。
当需要进行肌瘤切除术时，由于在输卵管成形术时进行肌瘤切除术没有弊端，联合手术方法应是首选，而不是将肌瘤保留原位以便日后在单独手术中切除。
