Management of diffuse uterine leiomyomatosis for fertility preservation: Case series and systematic literature review

IF 1.6 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of Obstetrics and Gynaecology Research Pub Date : 2025-06-10 DOI:10.1111/jog.16332

Kiko Yamamoto, Kaoru Kawasaki, Kosuke Murakami, Yasushi Kotani, Noriomi Matsumura

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引用次数: 0

Abstract

Aim

The aim of this study was to evaluate the surgical, reproductive, and perinatal outcomes of patients with diffuse uterine leiomyomatosis desiring fertility preservation.

Methods

Patients diagnosed with diffuse uterine leiomyomatosis based on magnetic resonance imaging at Kindai University Hospital between 2017 and 2024 were included in a case series. A systematic literature review on diffuse uterine leiomyomatosis desiring fertility preservation was carried out.

Results

The case series showed that fertility preservation was desired in 8 of 18 cases, of which 1 was conceived after assisted reproductive technology and underwent cesarean section at 34 weeks of gestation for placenta previa accreta. A systematic literature review identified 31 cases from descriptive observational studies (1–8 cases per study). Although more fibroids (n = 87) were enucleated by extensive myomectomy than by hysteroscopic myomectomy (n = 33) (p < 0.0001), extensive myomectomy was often associated with massive blood loss and blood transfusion. Perinatal complications were more frequent in extensive myomectomy (5/7) compared to hysteroscopic myomectomy (2/12, p = 0.04). Preterm delivery before 36 weeks was more frequent in extensive myomectomy (4/6 cases) than in hysteroscopic myomectomy (1/11 cases, p = 0.03).

Conclusion

Fertility preservation in diffuse uterine leiomyomatosis was previously considered difficult, but it is now recognized to be possible. Hysteroscopic myomectomy is a minimally invasive option. If conception is not achieved, extensive myomectomy may be considered. However, extensive myomectomy is more invasive, with a higher risk of perinatal complications. Large-scale clinical trials are required to establish a management standard for diffuse uterine leiomyomatosis.

Abstract Image

查看原文本刊更多论文

弥漫性子宫平滑肌瘤病的治疗以保持生育能力：病例系列和系统文献综述

目的本研究的目的是评估希望保留生育能力的弥漫性子宫平滑肌瘤病患者的手术、生殖和围产儿结局。方法选取2017 ~ 2024年在金大医院经磁共振成像诊断为弥漫性子宫平滑肌瘤病的患者为研究对象。本文系统回顾了弥漫性子宫平滑肌瘤病希望保留生育能力的文献。结果18例患者中有8例需要保留生育能力，其中1例采用辅助生殖技术受孕，妊娠34周因前置胎盘行剖宫产。系统文献综述从描述性观察性研究中确定了31例（每项研究1-8例）。尽管广泛子宫肌瘤切除术比宫腔镜子宫肌瘤切除术（n = 33）切除了更多的肌瘤（n = 87）（p < 0.0001），但广泛子宫肌瘤切除术通常伴有大量失血和输血。广泛子宫肌瘤切除术的围产期并发症发生率（5/7）高于宫腔镜子宫肌瘤切除术（2/12,p = 0.04）。广泛子宫肌瘤切除术（4/6例）比宫腔镜子宫肌瘤切除术（1/11例，p = 0.03） 36周前早产发生率更高。结论弥漫性子宫平滑肌瘤病的生育能力保存以前被认为是困难的，但现在被认为是可能的。宫腔镜子宫肌瘤切除术是一种微创的选择。如果不能受孕，可以考虑广泛的子宫肌瘤切除术。然而，广泛子宫肌瘤切除术更具侵袭性，围产期并发症的风险更高。为建立弥漫性子宫平滑肌瘤病的治疗标准，需要大规模的临床试验。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Obstetrics and Gynaecology Research 医学-妇产科学

CiteScore

3.10

自引率

0.00%

发文量

376

审稿时长

3-6 weeks

期刊介绍： The Journal of Obstetrics and Gynaecology Research is the official Journal of the Asia and Oceania Federation of Obstetrics and Gynecology and of the Japan Society of Obstetrics and Gynecology, and aims to provide a medium for the publication of articles in the fields of obstetrics and gynecology. The Journal publishes original research articles, case reports, review articles and letters to the editor. The Journal will give publication priority to original research articles over case reports. Accepted papers become the exclusive licence of the Journal. Manuscripts are peer reviewed by at least two referees and/or Associate Editors expert in the field of the submitted paper.