Reproductive outcomes after intramural myoma myomectomy

Abstract

Uvod Intramuralni miomi su dobroćudni tumori nastali iz glatkog mišićnog i vezivnog tkiva maternice koji rastu unutar njene stjenke, većinom su asimptomatski, te se otkriju ginekološkim pregledom. Česta je istodobna pojava dva ili više manjih ili većih mioma. Liječenje ovisi o mnogo čimbenika i može biti medikamentozno, radiološko i kirurško. Utjecaj mioma na neplodnost još nije dovoljno istražen. Cilj ovog istraživanja bio je utvrditi utjecaj operacijskog liječenja intramuralnih mioma na začetak i tijek trudnoće, te sam porod u žena reprodukcijske dobi koje prije nisu rodile. ----- Metode Provedeno je retrospektivno istraživanje u kojem je uključeno osamnaest (18) žena koje su tijekom 2011.godine podvrgnute operacijskom liječenju intramuralnih mioma. Ispitivanje o reprodukcijskom ishodu provedeno je 2015. godine. Podaci o anamnezi, prijeoperacijskom liječenju, tijeku operacije, oporavku i boravku u bolnici, te o začetku, tijeku trudnoće i porodu prikupljeni su iz medicinske dokumentacije i povijesti bolesti bolesnica. ----- Rezultati Istraživanje je provedeno na osamnaest (18) bolesnica koje su bile u dobi od 20 do 42 godine sa medijanom od 34,5 godine. Od njih osamnaest (18), devet (9) je operirano laparatomijom, a devet (9) laparoskopski.. Od istih osamnaest (18), pet (5) ih nije planiralo trudnoću, a trinaest (13) je planiralo trudnoću. Od trinaest (13) pacijentica koje su željele trudnoću , devet (9) ispitanica je zatrudnjelo i rodilo, a četiri (4) nisu zanijele. ----- Zaključak Intramuralni miomi su vrlo česti dobroćudni tumori maternice, te se vrlo lako otkrivaju tijekom rutinskog ultrazvučnog ginekološkog pregleda. Dosadašnja istraživanja nisu utvrdila utječe li kirurško uklanjanje intramuralnih mioma na poboljšanje ishoda liječenja plodnosti. Zbog premalog uzorka u ovom istraživanju nemoguće je izvesti i utvrditi statistički relevantan zaključak. Potrebna su daljnja istraživanja na većem uzorku kako bi se utvrdio učinak kirurškog odstranjenja intramuralnih mioma kod žena koje nisu prethodno rodile na poboljšanje reprodukcijskog ishoda.Introduction Intramural fibroids are benign tumors that grow within the wall of the uterus, most are asymptomatic and are discovered by gynecological examination. Frequently there is simultaneous occurrence of two or more smaller or larger fibroids. Treatment depends on many factors and may be hormonal, radiological and surgical. The impact of fibroids on fertility has not been sufficiently explored. The aim of this study was to determine the effect of surgical treatment of intramural fibroids at the beginning , the course of pregnancy and the birth itself in women of reproductive age who have not given birth before. ----- Methods Retrospective study was made, which included 18 women who were subjected to operating treatment of intramural fibroids during the 2011. The reproductive outcome of the respondents was investigated until 2015. Data on history, preoperative treatment, ongoing operations, and recovery room at the hospital, and the beginning, during pregnancy and childbirth were collected from medical records and medical histories of patients. ----- Results The study was conducted on eighteen (18) of patients, aged 20-42 years with a median of 34.5 years. From eighteen (18), nine (9) were operated by laparotomy and nine (9) laparoscopic. From the same eighteen (18), five (5) of them didn`t plan pregnancy, and thirteen (13) planned pregnancy. Of the thirteen (13) patients who wanted pregnancy, nine (9) women was pregnant and gave birth, and four of them (4) didn`t . ----- Conclusion Intramural fibroids are very common benign tumors of the uterus, and is very easily discovered during a routine ultrasound gynecological examination. Previous studies did not determine if the surgical removal of intramural fibroid affects fertility improving outcomes. Due to the small sample in this study, it is impossible to carry out and establish statistically relevant conclusion. Further prospective studies with longer follow-up to evaluate the effect of surgical removal of intramural fibroids in women who have not previously given birth are needed