| 摘要: |
| ［摘要］ 目的 分析弥漫性子宫平滑肌瘤病（DUL）患者在宫腔镜下子宫肌瘤去除术（HM）后的生殖结局。方法 回顾性分析2019年8月至2025年5月于首都医科大学附属北京天坛医院接受HM治疗的、有生育要求的43例DUL患者的临床资料，分析患者治疗的有效性、安全性及其妊娠结局。结果 43例DUL患者中，38例（88.37%）主要表现为月经量增多及经期延长，5例（11.63%）无明显症状。手术次数共108次，中位数为2.0次。在二次宫腔镜检查中，17例（39.53%）存在宫腔粘连。HM术中共有7例患者发生液体超负荷与血管内吸收（OHIA）综合征，其中双极电切4例，单极电切3例。所有患者均未出现子宫穿孔、大出血及术后感染等并发症。术后41例完成随访，2例失访。中位随访时间为35.00个月，术后3个月月经改善率为90.24%（37/41），4例无明显改善，其中1例选择子宫切除术。术后妊娠14例（34.15%，14/41），末次HM术至妊娠的中位时间为3.00个月，活产率为71.43%（10/14），早产1例，足月分娩9例。产后出血5例，胎盘粘连2例。妊娠组患者的年龄、体质量指数（BMI）及子宫体积显著低于未妊娠组（P<0.05）。结论 对于有生育要求的DUL患者，分阶段HM是一种可采取的微创治疗策略，要关注宫腔镜术中OHIA综合征的发生风险及术后宫腔粘连的预防和管理。术后妊娠属于高危妊娠，需加强围产期管理。 |
| 关键词: 弥漫性子宫平滑肌瘤病 宫腔镜下子宫肌瘤去除术 生殖预后 |
| DOI：10.3969/j.issn.1674-3806.2026.06.03 |
| 分类号:R 737.33 |
| 基金项目: |
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| Hysteroscopic myomectomy for diffuse uterine leiomyomatosis: clinical application and reproductive prognosis |
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ZHANG Shengpeng, ZHANG Luping, ZHANG Diqing, FENG Limin
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Department of Obstetrics and Gynecology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
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| Abstract: |
| ［Abstract］ Objective To analyze the reproductive outcomes of patients with diffuse uterine leiomyomatosis(DUL) after hysteroscopic myomectomy(HM). Methods A retrospective analysis was conducted on the clinical data of 43 DUL patients with fertility requirements who received HM treatment in Beijing Tiantan Hospital, Capital Medical University from August 2019 to May 2025. The effectiveness and safety of HM treatment in the DUL patients and their pregnancy outcomes were analyzed. Results Among the 43 DUL patients, 38 patients(88.37%) mainly presented with heavy menstrual flow and prolonged menstrual period, while 5 patients(11.63%) had no obvious symptoms. A total of 108 operations were performed on the patients, with a median of 2.0 operations. During the second hysteroscopy, intrauterine adhesions were observed in 17 cases(39.53%). Seven patients developed operative hysteroscopy intravascular absorption(OHIA) syndrome during HM, among whom 4 patients were treated with bipolar resection and 3 patients were treated with monopolar resection. No complications such as uterine perforation, massive hemorrhage and postoperative infection occurred in all the patients. A total of 41 patients were followed up after the operation, and 2 patients were lost to follow-up. The median follow-up duration was 35.00 months. The menstrual improvement rate at 3 months postoperatively was 90.24%(37/41). However, 4 patients showed no significant improvement, among whom 1 patient opted for hysterectomy. Postoperative pregnancy was achieved in 14 cases(34.15%, 14/41), with median duration of 3.00 months from the last HM to pregnancy. The live birth rate was 71.43%(10/14), with 1 case of premature delivery and 9 cases of full-term delivery. There were 5 cases of postpartum hemorrhage and 2 cases of placental adhesions. The age, body mass index(BMI) and uterine volume of the patients in the pregnancy group were significantly lower than those of the patients in the non-pregnancy group(P<0.05). Conclusion For DUL patients with fertility requirements, staged HM is a feasible and minimally invasive therapeutic strategy. Attention should be paid to the occurrence risk of OHIA syndrome during hysteroscopy and the prevention and management of postoperative intrauterine adhesions. The pregnancy of DUL patients is considered a high-risk pregnancy, and perinatal management needs to be strengthened for them. |
| Key words: Diffuse uterine leiomyomatosis(DUL) Hysteroscopic myomectomy(HM) Reproductive prognosis |
