子宫肌瘤剔除术后，宫腔粘连的发生率和危险因素！

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Objective

研究目的

To determine the incidence and risk factors for intrauterine adhesions (IUA) following minimally invasive, open and hysteroscopic myomectomy.

明确微创、经腹以及宫腔镜子宫肌瘤剔除术后宫腔粘连（IUA）的发生率和危险因素。

Materials and Methods

研究对象和方法

This was a retrospective cohort study conducted at single university-affiliated fertility center. Patients 18 and older undergoing robotic-assisted or conventional laparoscopic minimally invasive myomectomy (MIS), abdominal myomectomy (AM) or hysteroscopic myomectomy (HM) between January 2007 and January 2017. Only patients who underwent a uterine cavity evaluation within 12 months of surgery via hysteroscopy or hysterosalpingogram were included. Patients were excluded if they had a history of IUA prior to myomectomy. Severity of intrauterine adhesions were scored by two authors using a previously published grading system (March et al). The primary outcome(s) of this study were presence and severity of IUA. The secondary outcomes were identification of risk factors for IUA formation.

本研究是在一家大学附属的生殖中心进行的一项回顾性队列研究。研究对象为2007年1月至2017年1月间接受机器人辅助或传统腹腔镜微创子宫肌瘤剔除术（MIS）、经腹子宫肌瘤剔除术（AM）或宫腔镜子宫肌瘤剔除术（HM），年龄≥18岁的患者。纳入标准：患者在手术的12个月内通过宫腔镜或子宫输卵管造影评价过宫腔情况；手术之前就有IUA病史的患者被排除在外。有两位研究者根据宫腔粘连评分系统（March等）对粘连的严重程度进行评分。主要结局是IUA发生率与严重程度，次要结局为确定IUA形成的危险因素。

Results

研究结果

Of n=1315 patients who underwent myomectomy, n=173 (13.2%) met inclusion criteria. Intrauterine adhesions were identified in 9.3% of all patients, 75.0% of which were classified as minimal. The incidence of IUA did not vary by modality: 8.6% MIS, 7.8% AM, and 11.8% HM (p=0.800). There were no differences in incidence of IUA by number or size of fibroids removed (p>0.05). Of patients with IUA, 87.5% had submucosal fibroids resected compared to 58.6% without IUA (p=0.029).

1315名接受子宫肌瘤剔除术的患者中，173名（13.2%）符合标准而被纳入研究。宫腔粘连的发生率为9.3%，其中75%为轻度粘连。IUA的发生率与手术方式无关：MIS：8.6%，AM：7.8%，HM：11.8%（P=0.800）。IUA的发生率与子宫肌瘤的个数及大小无关（P＞0.05）。在发生宫腔粘连的患者中，87.5%的患者剔除的是粘膜下肌瘤，而未发生宫腔粘连的患者中，58.6%的患者剔除的是此型肌瘤（P=0.029）。

Conclusions

结论

The incidence of post-operative IUA in women undergoing myomectomy of any modality is relatively low (9.3%) and does not vary by modality alone. Most IUA are of minimal degree. The presence of submucous fibroids is associated with increased risk of IUA in all modalities.

无论接受何种方式的子宫肌瘤剔除术，术后宫腔粘连的发生率均较低，且不因术式而异。大多数宫腔粘连都是轻度的。但粘膜下肌瘤增加了所有术式术后发生宫腔粘连的风险。

Impact Statement

影响声明

In summary, based on the 10-year experience of a single, large academic center’s with multi-modality myomectomy for patients desiring future childbearing, we report an incidence of post-operative intrauterine adhesions of 9.3% which did not vary significantly by the surgical modality utilized. Furthermore, aside from the presence of submucous fibroids, there were no readily identifiable risk factors associated with IUA formation.

综上所述，基于单一的大型学术中心，历时10年，针对有生育要求的采取多种子宫肌瘤剔除的术式的患者的研究，我们报道的术后宫腔粘连的发生率为9.3%，且各种术式间无显著差异。此外，除了粘膜下子宫肌瘤，未发现明显的与术后宫腔粘连相关的危险因素。

文章来源：

INCIDENCE AND RISK FACTORS OF INTRAUTERINE ADHESIONS FOLLOWING MYOMECTOMY Bortoletto, Pietro et al.Fertility and Sterility, Volume 118, Issue 4, e228