| Objective:The fertility of the patients was improved after submucosal hysteromyoma resection under hysteroscopy.However,due to the different types,sizes,locations and Numbers of submucosal hysteromyoma,the factors affecting pregnancy after submucosal hysteromyoma resection under hysteroscopy were different.This study analyzed the factors affecting pregnancy after submucosal hysteromyoma resection under hysteroscopy,aiming to provide basis for clinical treatment and further evaluation of fertility of patients with submucosal hysteromyoma who have fertility requirements.Methods:Choosing between December 2010 and February 2019 in the second hospital of shanxi medical university line under hysteroscopy submucosal uterine fibroids electricity cut method and patients with fertility requirements,were retrospectively analyzed the clinical data of patients and postoperative follow-up pregnancies,compare the postoperative conception and not pregnant patient information,analysis influence under hysteroscopy submucosal uterine fibroids cutting factors of postoperative pregnancy.The clinical data included preoperative demographic information,preoperative characteristics and intraoperative characteristics,among which preoperative demographic information included age,body mass index and smoking status.Preoperative features include the history of miscarriage,number of miscarriages,physical examination,laboratory examination and imaging examination.Intraoperative features included intraoperative maximum submucosal myoma diameter,submucosal myoma type,number of submucosal myomas removed,amount of bleeding,and time of entry into the uterine cavity.Postoperative pregnancy includes pregnancy or not,operation time between the first pregnancy,assisted reproduction.The follow-up time was 1 year.SPSS21.1 was used for statistical analysis of the data.Count data(including age,body mass index,smoking status,hemoglobin,abortion history,number of abortions,number of submucosal uterine fibroids removed,type of submucosal uterine fibroids)were presented by frequency and percentage.The comparison between groups was conducted by the 2 test.The measurement data were consistent with normal distribution(including preoperative maximum submucosal myoma diameter),and the statistical description was expressed as mean ± standard deviation,and the independent sample t test was used for inter-group comparison.The statistical description of inconformity with normal distribution(including intrauterine operation time,blood loss,intraoperative maximum submucosal myoma diameter)was expressed by median(quartile),and the rank-sum test was used for inter-group comparison.The multivariate analysis was carried out by unconditional Logistic regression.P < 0.05 was statistically significant.Results:From December 2010 to February 2019,a total of 628 cases of submucosal hysteromyoma underwent hysteroscopic electrotomy,among which 167 cases were selected for the study due to fertility requirements,and 155 cases were included in the standard due to the exclusion of 12 cases in the follow-up.The overall clinical pregnancy rate was 51.6%(n=80)after hysteroscopic submucosal hysteromyoma resection,and the interval of the first postoperative pregnancy was 1-12 months,with an average of(5.66±3.93)months.The Relationship between age and postoperative pregnancy: univariate analysis results showed that the difference of age on postoperative pregnancy was statistically significant(P < 0.01),? postoperative pregnancy rate of 71.30% at 34 years old,and postoperative pregnancy rate of 6.38% at 34 years old at >.Logistic multivariate analysis showed that age was one of the independent risk factors affecting pregnancy after hysteroscopic submucosal hysteromyoma resection(OR=0.133,95% confidence interval [CI] : 0.049-0.358,P< 0.01),and the postoperative pregnancy rate of women ?34 years old was 7.69(1/0.13)times that of women aged > 34 years old.Submucosal uterine flesh tumour type and the relationship between postoperative pregnancy: submucosal uterine flesh tumour types as indicators for statistical analysis,single factor analysis results show that the difference was statistically significant(P< 0.01),and type 0 conception rate 74.36% postoperatively in patients with submucosal uterine fibroids,conception rate 52.63% postoperatively in patients with type I submucosal uterine fibroids,conception rate 20.69% postoperatively in patients with type II submucosal uterine fibroids.Analysis: Logistic multiple factors showed that submucosal uterine fibroids type is under hysteroscopy submucosal uterine fibroids electricity cut another independent risk factors of postoperative pregnancy,and type 0 submucous uterine myoma postoperative conception rate is highest,with zero probability of pregnancy is one type of type II 14.31(1/6.99)times,type I pregnant probability is 16.36(1/6.11)times of type II.The relationship between preoperative abortion history and postoperative pregnancy: a statistical analysis was conducted with the history of abortion as an indicator,and the single-factor analysis showed that the difference in the influence of preoperative abortion history on postoperative pregnancy was statistically significant(P< 0.01).The pregnancy rate was 72.88%(43/59).The pregnancy rate of the patients with pre-operative abortion(induced abortion or medical abortion)was 30.30%(20/66).The pregnancy rate of preoperative spontaneous abortion patients was 56.67%(17/30).Logistic multivariate analysis showed that there was no significant difference in the influence of abortion on postoperative pregnancy.The relationship between preoperative abortion frequency and postoperative pregnancy: univariate analysis showed that the difference of preoperative abortion frequency on postoperative pregnancy was statistically significant(P< 0.01).Compared with patients with a history of abortion(1 time,2 times,?3 times),patients without a history of abortion before surgery had a higher pregnancy rate after surgery.There was no significant difference in the postoperative pregnancy rate between the preoperative history of 1 abortion and the preoperative history of 2 abortions(?2=0.203,P=0.625).The pregnancy rate of 1 abortion history before surgery was higher than that of ?3 abortion history before surgery(?2=5.934,P=0.015).The pregnancy rate of 2 pre-operative abortions was higher than that of ?3 pre-operative abortions(?2=4.400,P=0.036).Logistic multivariate analysis showed that the number of abortions had no statistical significance on postoperative pregnancy(P=0.104).In addition,this study to body mass index,smoking status,hemoglobin concentration,physical size of the uterus,preoperative maximum diameter of submucosal uterine fibroids,remove fibroids number,enter the uterine cavity operation time,blood loss,intraoperative submucosal uterine fibroids largest single factor statistical analysis with diameter index respectively,the results showed that there were no statistically significant difference.In this study,a total of 80 women were pregnant,of which 74(92.5%)were conceived naturally and 6(7.5%)were conceived using assisted reproductive technology(ivf-embryo transfer).Conclusion:1.Age and submucosal myoma type were independent risk factors for pregnancy after submucosal myoma resection under hysteroscopy2.Preoperative abortion history and number of abortions may be factors affecting pregnancy after submucosal hysteromyoma electrotomy under hysteroscopy. |
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