The Clinical Effect And Pregnancy Outcome Of Different Surgical Methods For The Removal Of Uterine Fibroids Clinical Research

Objectives:Through the first affiliated hospital of kunming medical university gynecology,a total of 260 cases of uterine fibroids with surgical indications and fertility needs were confirmed by gynecological b-ultrasound,line of laparoscopic uterine myoma eliminating technique(laparoscopic myomectomy,LM)uterinefibroids rejecting operation and laparotomy(transabdominal myomectomy,TAM)weed out after two kinds of operation mode,the clinical effects and pregnancy outcomes of different treatment groups were retrospectively analyzed,so as to provide valuable basis for the treatment of uterine fibroids and postoperative pregnancy supervision.Methods:From January 1,2014 to December 31,2015,260 cases of patients with postoperative pregnancy need who were admitted to the first affiliated hospital of kunming medical university for hysteromyomectomy were selected as subjects.All these patients were diagnosed as uterine fibroids by gynecological b-ultrasound,which was confirmed during the surgery,and the postoperative disease examination suggested benign uterine fibroids.According to the different surgical methods,the patients were divided into 125 TAM patients(control group)and 135 LM patients(experimental group).The follow-up period was 3-5 years,including the operation time during the operation,intraoperative bleeding,postoperative ventilation time,and the average postoperative hospital stay.Postoperative fibroid residual rate,recurrence rate,pregnancy rate,neonatal outcome,surgical complications,etc.Data obtained SPSS 17.0 statistical software analysis,measurement data using mean±standard deviation(x±s)),using t test,counting data adoption rate percentage(%),said theX2test,how to classify data using Logistic regression analysis.Results:1.Comparison of mean operation time,average intraoperative blood loss,postoperative anal exhaust time and postoperative mean hospital stay between two groups of patients with uterine fibroids:average operation time of TAM group was 94.20±35.09 minutes(min),average intraoperative blood loss was 114.96 ± 70.66 ml(ml),average postoperative anal exhaust time was 42.43 ± 10.62 hours(h),and average postoperative hospital stay was 5.96±1.85 days(d).The average operative time of LM group was 109.22±31.60 minutes(min),the average intraoperative blood loss was 80.30±50.03 ml(ml),the average postoperative anal exhaust time was 27.20±8.70 hours(h),and the average postoperative hospital stay was 5.07±1.14 days(d).The operation time in LM group was longer than TAM group P<0.05,while the intraoperative blood loss,postoperative ventilation time and average postoperative hospital stay in LM group were all less than TAM group P<0.05.2.Comparison of pregnancy rate,fibroid residual rate and fibroid recurrence rate between the two groups at 3-5 years after surgery:52 cases of normal pregnancy(41.6%)were found in TAM group,4 cases of multiple fibroid residual(3.2%),0 cases of single fibroid residual(0.0%),and 29 cases of fibroid recurrence(23.2%).There were 75 cases(55.6%)of normal postoperative pregnancy in LM group,23 cases(17.1%)of multiple fibroid residues,3 cases(2.2%)of single fibroid residues,and 36 cases(28.8%)of fibroid recurrence in LM group,the pregnancy rate and residual rate of multiple fibroids in LM group were higher than TAM group(P<0.05),and there was no difference in the residual rate of single fibroids and recurrence rate of fibroids between the two groups(P<0.05).3.Comparison of two groups of patients with postoperative pregnancy childbirth way,TAM group of 40 cases(76.9%)in 52 cases of pregnancy cesarean delivery,9 cases(17.3%)vaginal natural childbirth,3 cases(5.8%)vaginal midwifery,pregnancy,75 cases of postoperative patients with LM group,60 cases of cesarean section delivery(80%)of the line,line 11 cases(14.7%)vaginal natural childbirth,4 cases(5.3%)vaginal midwifery.There was no difference in cesarean section rate,vaginal spontaneous delivery rate and vaginal midwife-delivery rate between the two groups,P<0.05,no uterine rupture or threatened uterine rupture occurred in 127 cases.4.Complications and adverse pregnancy were compared between the two groups:8 cases of intraoperative hemorrhage 500ml in TAM group,5 cases of spontaneous abortion,0 cases of missed abortion,1 case of IVF failure,1 case of ectopic pregnancy,1 case of pulmonary embolism,1 case of lower limb venous thrombosis,1 case of fetal retardation,8 cases of postpartum hemorrhage;In the experimental group,there were 6 cases of intraoperative hemorrhage 500ml,5 cases of spontaneous abortion,2 cases of missed abortion,1 case of IVF failure,1 case of ectopic pregnancy,0 cases of pulmonary embolism,0 cases of lower limb venous thrombosis,0 cases of fetal retardation,and 12 cases of postpartum hemorrhage.There was no difference in complications between the two groups,P>0.05.5.Comparison of neonatal outcomes between the two groups:7 cases of neonatal jaundice in TAM group,2 cases of neonatal asphyxia,5 cases of giant infant,2 cases of low birth weight infant,8 cases of neonatal fever and 2 cases of neonatal pneumonia;In LM group,there were 5 cases of neonatal jaundice,4 cases of neonatal asphyxia,7 cases of macrosomia,5 cases of low birth weight,10 cases of neonatal fever and 5 cases of neonatal pneumonia.There was no difference in neonatal complications between the two groups,P>0.05.6.Multivariate analysis of factors influencing postoperative pregnancy of patients:surgical method and age were the factors influencing postoperative pregnancy,all P<0.05;postoperative pregnancy rate of LM was 8.9 times that of TAM;postoperative pregnancy rate of patients<35 years old was 1.8 times that of patients 35 years old;preoperative removal of fibroid type and fibroid location had no effect on postoperative pregnancy rate,all P<0.05.Conclusions:1.LM surgery for uterine fibroids has the advantages of less intraoperative bleeding,early postoperative ventilation,and short postoperative mean hospital stay.2.Patients with uterine fibroids had a higher pregnancy rate after LM surgery(55.6%).3.For uterine fibroids with surgical indications,LM surgery is the optimal choice under the premise of LM indications.4.Age after hysteromyoma surgery is an independent risk factor for pregnancy,and the older the patient is,the lower the pregnancy rate will be.5.There is a risk of uterine fibroids recurrence after surgery.Patients with fertility needs should be guided to the appropriate contraceptive time to avoid the recurrence of fibroids affecting the postoperative pregnancy rate.