Sestre Milosrdnice University hospital and Institute of Clinical Medical Research
Abstract
The aim of the present study was to analyze the effect of abdominal myomectomy on subsequent fertility. Medical records of 78 women having undergone myomectomy between 1980 and 2000 were retrospectively analyzed. A questionnaire was e-mailed to all women. The overall pregnancy rate in 66 patients that attempted pregnancy following myomectomy was 59.1%. The pre-myomectomy abortion rate of 35.4% fell to 22% after myomectomy. The incidence of cesarean section before and after myomectomy was 7.3 and 15.6%, respectively. Age above 30 at the time of myomectomy significantly reduced the chance of conception (P<0.0001). Subsequent fertility was significantly reduced by greater number and deeper localization of myomas (P<0.005 to P<0.001). The coexistence of pelvic infection and adhesiolysis significantly reduced the pregnancy rate (P<0.0001). Recurrence of uterine leiomyomas was recorded in 12.8% of study patients. More than half of the women with uterine leiomyomas were able to conceive and nearly half (48.5%) of them were able to bear children following myomectomy. Patient age at the time of myomectomy, the number and localization of leiomyomas, and coexistence of pelvic adhesions significantly reduced subsequent fertility. In spite of the emergence of new treatment options, it is evident that conventional abdominal myomectomy still has a major role in the treatment of women with fibroids.Cilj studije bio je analizirati utjecaj abdominalne miomektomije na kasniju plodnost. Od 1980. do 2000. godine miomi su enukleirani u 236 žena. Na upitnik je odgovorilo 78 (33,1%) žena, a od 66 žena koje su željele zatrudnjeti zanijelo ih je 39 (59,1%). Pojavnost spontanih pobačaja od 35,4% prije miomektomije smanjila se na 22% nakon operacije, a dovršenje trudnoće carskim rezom povisilo se sa 7,3% na 15,6%. Dob bolesnica iznad 30 godina u vrijeme operacije znakovito smanjuje izglede za začeće (P<0,0001). Veći broj mioma i njihova dublja lokalizacija znakovito smanjuju kasniju plodnost (P<0,005 do P<0,001). Istodobna prisutnost zdjelične upalne bolesti i operacijskog zahvata radi rješavanja priraslica znakovito smanjuju kasniju stopu začeća (P<0,0001). Ponovno javljanje mioma nakon operacije zabilježeno je u 12,8% žena. Više od polovice žena s miomima zainteresiranih za trudnoću je zanijelo, a gotovo polovica (48,5%) ih je rodila nakon miomektomije. životna dob bolesnice u vrijeme enukleacije mioma, broj i njihova lokalizacija te istodobna prisutnost priraslica u zdjelici znakovito smanjuju kasniju plodnost. Unatoč pojavljivanja novih terapijskih mogućnosti konvencionalna abdominalna miomektomija još uvijek igra glavnu ulogu u liječenju bolesnica s miomima
