前沿 | 既往剖宫产子宫肌瘤剔除术后单胎妊娠的长期产科、围产期和手术并发症：一项多中心回顾性研究

IF 1.6 4区医学 Q2 SURGERY

Frontiers in Surgery Pub Date : 2024-07-16 DOI:10.3389/fsurg.2024.1430439

Oğuz Güler, Şafak Hatırnaz, Radmila Sparic, Alper Basbug, Onur Erol, Üzeyir Kalkan, Hasan Ulubaşoğlu, Giuseppe Trojano, Sebati Sinan Ürkmez, Andrea Tinelli

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引用次数: 0

摘要

目的以往的研究已经证实了剖宫产子宫肌瘤剔除术的安全性。我们的研究旨在通过比较不同的子宫肌瘤剔除术（CM）技术，揭示剖宫产子宫肌瘤剔除术（CM）的长期围产期、产科和手术结果。材料和方法这项回顾性多中心病例对照研究涉及 7 家医院，纳入了 2015 年至 2020 年间接受重复剖宫产术（CS）的 226 例单胎妊娠。在这些孕妇中，226 例中有 113 例有 CM（A 组），113 例仅有 CS（B 组）。在进行了子宫肌瘤剔除术的 113 例中，58 例进行了子宫内膜肌瘤剔除术（EM）（A1 组），55 例进行了浆膜肌瘤剔除术（SM）（A2 组）。两组在产科、围产期和手术结果方面进行了比较，并对子宫肌瘤复发、肌瘤疤痕愈合率和粘连形成进行了记录。结果两组在产妇年龄、体重指数、孕产妇、奇偶数和前次CS的肌瘤直径方面无显著差异（P>0.05）。在围产期和产科评估中，各组在新生儿体重、Apgar 评分、胎儿生长受限、胎膜早破、早产、妊娠高血压和糖尿病方面无明显差异（P > 0.05）。肌瘤复发率为 28.3%，肌瘤疤痕良好愈合率为 99.1%。在CS持续时间、术前和术后血红蛋白水平、围手术期输血率、发热发病率和住院时间延长方面，两组之间没有差异（P > 0.05）。在粘连形成方面，虽然 SM 组的粘连率高于 EM 组，但两组间的差异无统计学意义。产科医生可以放心使用 CM（经子宫内膜或浆膜技术），因为它是一种安全有效的方法，且具有长期效果。

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Frontiers | Long-term obstetric, perinatal, and surgical complications in singleton pregnancies following previous cesarean myomectomy: a retrospective multicentric study

ObjectivesThe safety of cesarean myomectomy has been proven by previous studies. Our study aimed to reveal the long-term perinatal, obstetric, and surgical outcomes of cesarean myomectomy (CM) by comparing different CM techniques.Material and methodsThis retrospective multicentric case–control study involved 7 hospitals and included 226 singleton pregnancies that underwent repeated cesarean section (CS) between 2015 and 2020. Among these pregnancies, 113 of 226 cases had CM (Group A), and 113 had only CS (Group B). Of the 113 cases in which CM was performed, 58 underwent endometrial myomectomy (EM) (Subgroup A1) and 55 underwent serosal myomectomy (SM) (Subgroup A2). The groups were compared in terms of obstetric, perinatal, and surgical outcomes, and fibroid recurrence, myomectomy scar healing rate, and adhesion formation were noted.ResultsThere was no significant difference between the groups in terms of maternal age, body mass index, gravidity, parity, and fibroid diameter in previous CS (p > 0.05). In the perinatal and obstetric evaluation of the groups, there was no significant difference between the groups in terms of neonatal weight, Apgar score, fetal growth restriction, preterm premature rupture of membranes, preterm delivery, hypertension in pregnancy, and diabetes mellitus (p > 0.05). The fibroid recurrence rate was 28.3%, and the myomectomy scar good healing rate was 99.1%. There was no difference between the groups in terms of CS duration, preoperative and postoperative hemoglobin levels, perioperative blood transfusion rates, febrile morbidity, and prolonged hospitalization (p > 0.05). In terms of adhesion formation, although the adhesion rate of the SM group was higher than that of the EM group, no statistically significant difference was detected between the groups.ConclusionThis study showed that in pregnancies following CM, obstetrical, perinatal, and surgical outcomes were unaffected. Obstetricians can safely use CM, either the trans-endometrial or serosal technique, as it is a safe and effective method with long-term results.

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来源期刊

Frontiers in Surgery Medicine-Surgery

CiteScore

1.90

自引率

11.10%

发文量

1872

审稿时长

12 weeks

期刊介绍： Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles. Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery. Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact. The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.