当院における腹腔鏡下子宮筋腫核出術後の妊娠に関する検討

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Compared to myomectomy by laparotomy, laparoscopic myomectomy (LM) results in less postoperative pain and a shorter hospital stay. Furthermore, LM has a particular advantage in that it reduces the risk of postoperative adhesions when pregnancy is desired. We evaluated the reproductive outcomes after LM including the risk factors in subsequent pregnancies. Among the 432 patients who underwent LM in our department between January 2005 and December 2010, 153 patients desired to preserve fertility. Among the 153 patients, 88 patients (58%) had a total of 107 pregnancies after LM. Of those, 71 pregnancies (66%) were spontaneous, 7 pregnancies (7%) required intrauterine insemination IUI), and 28 pregnancies (26%) required IVF. The mean (± SD) age was 36.1 ± 3.6 years in the pregnant group (88 patients), and was 38.2 ± 3.5 years in the non-pregnant group (65 patients). We found a negative correlation to achieving a pregnancy with patient age at the time of LM (HR: 0.94; 95% CI: 0.88-0.99; <I>P</I> = 0.039). The following reproductive outcomes were noted: 58 pregnancies (91%) were term deliveries, 6 pregnancies (9%) were preterm delivery (from 33 to 36 weeks), 27 pregnancies (28%) were spontaneous abortions, and one (1%) was an ectopic pregnancy. Although there was one silent uterine rupture in this study, the location of rupture was not at the site of a uterine scar. It is unclear whether the laparoscopic procedure is associated with the silent uterine rupture. We found that the main factor determining fertility after LM was patient age. Reproductive outcomes are relatively good following LM.

当院における腹腔鏡下子宮筋腫核出術後の妊娠に関する検討

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