子宫肌瘤合并不孕5例病例报告
摘要
子宫肌瘤是女性生殖系统的一种常见疾病,其对于女性生育能力的影响目前还存在争议。对于有生育要求的子宫肌瘤患者的进一步处理尚无明确定论。本文回顾性分析了浙江大学医学院附属妇产科医院2009年4月-2009年11月收治的5位子宫肌瘤合并不孕患者的诊治过程并复习近期国内外相关文献。结果显示,本文5位患者子宫肌瘤可能是导致患者不孕的因素之一,也可能对于患者生育能力无明显影响。引起宫腔形态异常的子宫肌瘤影响生育,手术能有效改善生育能力。
Uterine fibroids are the common disease of female reproductive system, and the prevalence is about 20%-50%. The influence of uterine fibroids on fertility remains debated. The treatment of uterine fibroids and infertility patients is still unclear. This report retrospectively analysis of the clinical data of 5 patients with uterine fibroids and infertility admitted to our hospital from April 2009 to November 2009.And the results show uterine fibroids may be one of the factor leads patients infertility, and may do not affect fertility outcomes. Fibroids with endometrial distortion are associated with decreased reproductive outcomes, and removal seems to confer benefit.
Uterine fibroids are the common disease of female reproductive system, and the prevalence is about 20%-50%. The influence of uterine fibroids on fertility remains debated. The treatment of uterine fibroids and infertility patients is still unclear. This report retrospectively analysis of the clinical data of 5 patients with uterine fibroids and infertility admitted to our hospital from April 2009 to November 2009.And the results show uterine fibroids may be one of the factor leads patients infertility, and may do not affect fertility outcomes. Fibroids with endometrial distortion are associated with decreased reproductive outcomes, and removal seems to confer benefit.
引文
1 Verkauf BS. Myomectomy for fertility enhancement and preservation.Fertil Steril 1992;58:1-15.
2 Myers ER, Barber MD, Gustilo-Ashby T, Couchman G, Matchar DB, McCrory DC. Management of uterine leiomyomata:what do we really know? Obstet Gynecol 2002; 100:8-17.
3 Payson M, Leppert P, Segars J. Epidemiology of myomas. Obstet Gynecol Clin North Am 2006;33:1-11.
4 Tindall, VR. Tumors of the corpus uteri. In Jeffcoate's Principle of Gynecology. 5th edn 1987. pp417-444.
5 Richards PA, Richards PD, Tiltman AJ. The ultrastructure of fibromyomatous myometrium and its relationship to infertility. Hum Reprod Update 1998;4:520-525.
6 Ng EH, Ho PC. Doppler ultrasound examination of uterine arteries on the day of oocyte retrieval in patients with uterine fibroids undergoing IVF. Hum Reprod 2002; 17:765-770.
7 Oliveira FG, Abdelmassih VG, Diamond MP, Dozortsev D, Melo NR, Abdelmassih R. Impact of subserosal and intramural uterine fibroids that do not distort the endometrial cavity on the outcome of in vitro fertilization-intracytoplasmic sperm injection. Fertil Steril 2004;81:582-587.
8 M.L. Casini, F. Rossi, R. Agostini and V. Unfer, Effect of the position of fibroids on fertility, Gynecol Endocrinol 22 (2006), pp.106-109.
9 Rackow BW, Arici A. Fibroids and in-vitro fertilization:which comes first? Curr Opin Obstet Gynecol.2005 Jun;17(3):225-31.
10 Oliveira FG, Abdelmassih VG, Diamond MP, Dozortsev D, Melo NR, Abdelmassih R. Impact of subserosal and intramural uterine fibroids that do not distort the endometrial cavity on the outcome of in vitro fertilization-intracytoplasmic sperm injection. Fertil Steril.2004 Mar;81(3):582-7.
11 Klatsky PC, Tran ND, Caughey AB, Fujimoto VY. Fibroids and reproductive
outcomes:a systematic literature review from conception to delivery. Am J Obstet Gynecol.2008 Apr;198(4):357-66.
12 Elizabeth A. Pritts M.D. William H. Parker M.D. and David L. Olive M.D. Fibroids and infertility:an updated systematic review of the evidence. Fertility and Sterility Volume 91, Issue 4, April 2009, Pages 1215-1223.
13 Jun SH, Ginsburg ES, Racowsky C, Wise LA, Hornstein MD. Uterine leiomyomas and their effect on in vitro fertilization outcome:a retrospective study. J Assist Reprod Genet.2001 Mar;18(3):139-43.
14 Healy DL, Trounson AO, Andersen AN. Female infertility:causes and treatment. Lancet.1994 Jun 18;343(8912):1539-44.
15 Templeton A. Infertility and the establishment of pregnancy-overview. Br Med Bull.2000;56(3):577-87.
16 Ozkan S, Murk W, Arici A. Endometriosis and infertility:epidemiology and evidence-based treatments. Ann N Y Acad Sci.2008 Apr; 1127:92-100.
17 Li. T. C, Mortimer. R, and Cooke. I. D. Myomectomy:aa retrospective study to examine reproductive performance before and after surgery. Hum. Reprod.1999 14, 1735-1740.
18 Acien, P. and Quereda, F. Abdominal myomectomy:results of a simple operative technique. Fertil Steril,1996,65,41-51.
19 Loret de Mola JR. Obesity and its relationship to infertility in men and women. Obstet Gynecol Clin North Am.2009 Jun;36(2):333-46, ix.
20 Practice Committee of American Society for Reproductive Medicine. Smoking and infertility. Fertil Steril.2008 Nov;90(5 Suppl):S254-9.
21 Foster WG, Neal MS, Han MS, Dominguez MM. Environmental contaminants and human infertility:hypothesis or cause for concern? J Toxicol Environ Health B Crit Rev.2008 Mar; 11 (3-4):162-76.
22 Klemetti R, Raitanen J, Sihvo S, Saarni S, Koponen P. Infertility, mental disorders and well-being-a nationwide survey. Acta Obstet Gynecol Scand.2010 Mar 2.
[1]Abrams P, Cardozol L, Fall M, et al The standardization of terminology of lower urinary tract function:Report from the Standardisation Subcommittee of the International Continence Society. Urology 2003:61:37-49.
[2]Fultz H, Burgio K, Diokno AC, Kinchen KH, Obenchain R, Bump RC.Burden of stress urinary incontinence for community-dwellingwomen. Am J Obstet Gynecol 2003; 189:1275-1282.
[3]Lam GW, Foldspang A, Elving LB, Mommsen S. Social context, social abstention, and problem recognition correlated with adult female urinary incontinence. Dan Med Bull 1992; 39:565-570.
[4]Wagner TH, Hu TW. Economic costs of urinary incontinence in 1995. Uology 1998; 51:355-361.
[5]Hunskaar S, Arnold EP, Burgio K, et al Epidemiology and natural history of urinary incontinence.Int Urogynecol J Pelvic Floor Dysfunct,2002,11:301-319.
[6]Brown JS, Nyberg Lm, Kusek Jw,,et al Proceedings of the national institute of diabetes and digestive and kidney diseases international symposium on epidemiologic issues in urinary incontinence in women. Am J Obstet Gynecol, 2003,188:S77-88.
[7]Tsai YC, Liu CH, et al Urinary incontinence among Taiwanese women:an outpatient study of prevalence, comorbidity, risk factors, and quality of life. Int Urol Nephrol.2009 Feb 6.
[8]Azuma R, Murakami K, et al Prevalence and risk factors of urinary incontinence and its influence on the quality of life of Japanese women. Nurs Health Sci.2008 Jun;10(2):151-8.
[9]Jennifer L. Wayne Katon, et al Urinary Incontinence in US Women:A Population-Based Study.Arch Intern Med.2005;165:537-542.
[10]Song Yan-feng, ZHANG wen-ju et al Prevalence and risk factors of urinary incontinence in Fuzhou Chinese women.Chinese Medical Journal 2005:118(11):887-892
[11]MW Pang, HY Leung, et al The impact of urinary incontinence on quality of life among women in Hong Kong.Hong Kong Med J 2005; 11:158-63
[12]Choo MS, Ku JH, et al Prevalence of urinary incontinence in Korean women:an epidemiologic survey. Int Urogynecol J Pelvic Floor Dysfunct.2007 Nov;18(11):1309-15. Epub 2007 Feb 15.
[13]Buckley BS, Lapitan MC. Prevalence of urinary and faecal incontinence and nocturnal enuresis and attitudes to treatment and help-seeking amongst a community-based representative sample of adults in the United Kingdom. Int J Clin Pract.2009 Apr;63(4):568-73. Epub 2009 Jan 26.
[14]Coyne KS, Sexton CC,et al The prevalence of lower urinary tract symptoms (LUTS) in the USA, the UK and Sweden:results from the Epidemiology of LUTS (EpiLUTS) study. BJU Int.2009 Aug;104(3):352-60. Epub 2009 Mar 5
[15]Jittima Manonai, Aporn Poowapirom, et al Female urinary incontinence:a cross-sectional study from a Thai rural area. Int Urogynecol J(2006) 17:321-325
[16]Onur R, Deveci SE,et al Prevalence and risk factors of female urinary incontinence in eastern Turkey. Int J Urol.2009 Jun;16(6):566-9. Epub 2009 Apr 28
[17]Tozun M, Ayranci U, Unsal A. Prevalence of urinary incontinence among women and its impact on quality of life in a semirural area of Western Turkey. Gynecol Obstet Invest.2009;67(4):241-9. Epub 2009 Mar 24.
[18]El-Azab AS, Mohamed EM, Sabra HI. The prevalence and risk factors of urinary incontinence and its influence on the quality of life among Egyptian women. Neurourol Urodyn.2007;26(6):783-8.
[19]Lee KS, Sung HH, Na S, Choo MS. Prevalence of urinary incontinence in Korean women:results of a National Health Interview Survey. World J Urol.2008 Apr;26(2):179-85. Epub 2008 Feb 12.
[20]Wennberg AL, Molander U, Fall M, Edlund C, Peeker R, Milsom I. A longitudinal population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in women. Eur Urol.2009 Apr;55(4):783-91. Epub 2009 Jan 13.
2 Myers ER, Barber MD, Gustilo-Ashby T, Couchman G, Matchar DB, McCrory DC. Management of uterine leiomyomata:what do we really know? Obstet Gynecol 2002; 100:8-17.
3 Payson M, Leppert P, Segars J. Epidemiology of myomas. Obstet Gynecol Clin North Am 2006;33:1-11.
4 Tindall, VR. Tumors of the corpus uteri. In Jeffcoate's Principle of Gynecology. 5th edn 1987. pp417-444.
5 Richards PA, Richards PD, Tiltman AJ. The ultrastructure of fibromyomatous myometrium and its relationship to infertility. Hum Reprod Update 1998;4:520-525.
6 Ng EH, Ho PC. Doppler ultrasound examination of uterine arteries on the day of oocyte retrieval in patients with uterine fibroids undergoing IVF. Hum Reprod 2002; 17:765-770.
7 Oliveira FG, Abdelmassih VG, Diamond MP, Dozortsev D, Melo NR, Abdelmassih R. Impact of subserosal and intramural uterine fibroids that do not distort the endometrial cavity on the outcome of in vitro fertilization-intracytoplasmic sperm injection. Fertil Steril 2004;81:582-587.
8 M.L. Casini, F. Rossi, R. Agostini and V. Unfer, Effect of the position of fibroids on fertility, Gynecol Endocrinol 22 (2006), pp.106-109.
9 Rackow BW, Arici A. Fibroids and in-vitro fertilization:which comes first? Curr Opin Obstet Gynecol.2005 Jun;17(3):225-31.
10 Oliveira FG, Abdelmassih VG, Diamond MP, Dozortsev D, Melo NR, Abdelmassih R. Impact of subserosal and intramural uterine fibroids that do not distort the endometrial cavity on the outcome of in vitro fertilization-intracytoplasmic sperm injection. Fertil Steril.2004 Mar;81(3):582-7.
11 Klatsky PC, Tran ND, Caughey AB, Fujimoto VY. Fibroids and reproductive
outcomes:a systematic literature review from conception to delivery. Am J Obstet Gynecol.2008 Apr;198(4):357-66.
12 Elizabeth A. Pritts M.D. William H. Parker M.D. and David L. Olive M.D. Fibroids and infertility:an updated systematic review of the evidence. Fertility and Sterility Volume 91, Issue 4, April 2009, Pages 1215-1223.
13 Jun SH, Ginsburg ES, Racowsky C, Wise LA, Hornstein MD. Uterine leiomyomas and their effect on in vitro fertilization outcome:a retrospective study. J Assist Reprod Genet.2001 Mar;18(3):139-43.
14 Healy DL, Trounson AO, Andersen AN. Female infertility:causes and treatment. Lancet.1994 Jun 18;343(8912):1539-44.
15 Templeton A. Infertility and the establishment of pregnancy-overview. Br Med Bull.2000;56(3):577-87.
16 Ozkan S, Murk W, Arici A. Endometriosis and infertility:epidemiology and evidence-based treatments. Ann N Y Acad Sci.2008 Apr; 1127:92-100.
17 Li. T. C, Mortimer. R, and Cooke. I. D. Myomectomy:aa retrospective study to examine reproductive performance before and after surgery. Hum. Reprod.1999 14, 1735-1740.
18 Acien, P. and Quereda, F. Abdominal myomectomy:results of a simple operative technique. Fertil Steril,1996,65,41-51.
19 Loret de Mola JR. Obesity and its relationship to infertility in men and women. Obstet Gynecol Clin North Am.2009 Jun;36(2):333-46, ix.
20 Practice Committee of American Society for Reproductive Medicine. Smoking and infertility. Fertil Steril.2008 Nov;90(5 Suppl):S254-9.
21 Foster WG, Neal MS, Han MS, Dominguez MM. Environmental contaminants and human infertility:hypothesis or cause for concern? J Toxicol Environ Health B Crit Rev.2008 Mar; 11 (3-4):162-76.
22 Klemetti R, Raitanen J, Sihvo S, Saarni S, Koponen P. Infertility, mental disorders and well-being-a nationwide survey. Acta Obstet Gynecol Scand.2010 Mar 2.
[1]Abrams P, Cardozol L, Fall M, et al The standardization of terminology of lower urinary tract function:Report from the Standardisation Subcommittee of the International Continence Society. Urology 2003:61:37-49.
[2]Fultz H, Burgio K, Diokno AC, Kinchen KH, Obenchain R, Bump RC.Burden of stress urinary incontinence for community-dwellingwomen. Am J Obstet Gynecol 2003; 189:1275-1282.
[3]Lam GW, Foldspang A, Elving LB, Mommsen S. Social context, social abstention, and problem recognition correlated with adult female urinary incontinence. Dan Med Bull 1992; 39:565-570.
[4]Wagner TH, Hu TW. Economic costs of urinary incontinence in 1995. Uology 1998; 51:355-361.
[5]Hunskaar S, Arnold EP, Burgio K, et al Epidemiology and natural history of urinary incontinence.Int Urogynecol J Pelvic Floor Dysfunct,2002,11:301-319.
[6]Brown JS, Nyberg Lm, Kusek Jw,,et al Proceedings of the national institute of diabetes and digestive and kidney diseases international symposium on epidemiologic issues in urinary incontinence in women. Am J Obstet Gynecol, 2003,188:S77-88.
[7]Tsai YC, Liu CH, et al Urinary incontinence among Taiwanese women:an outpatient study of prevalence, comorbidity, risk factors, and quality of life. Int Urol Nephrol.2009 Feb 6.
[8]Azuma R, Murakami K, et al Prevalence and risk factors of urinary incontinence and its influence on the quality of life of Japanese women. Nurs Health Sci.2008 Jun;10(2):151-8.
[9]Jennifer L. Wayne Katon, et al Urinary Incontinence in US Women:A Population-Based Study.Arch Intern Med.2005;165:537-542.
[10]Song Yan-feng, ZHANG wen-ju et al Prevalence and risk factors of urinary incontinence in Fuzhou Chinese women.Chinese Medical Journal 2005:118(11):887-892
[11]MW Pang, HY Leung, et al The impact of urinary incontinence on quality of life among women in Hong Kong.Hong Kong Med J 2005; 11:158-63
[12]Choo MS, Ku JH, et al Prevalence of urinary incontinence in Korean women:an epidemiologic survey. Int Urogynecol J Pelvic Floor Dysfunct.2007 Nov;18(11):1309-15. Epub 2007 Feb 15.
[13]Buckley BS, Lapitan MC. Prevalence of urinary and faecal incontinence and nocturnal enuresis and attitudes to treatment and help-seeking amongst a community-based representative sample of adults in the United Kingdom. Int J Clin Pract.2009 Apr;63(4):568-73. Epub 2009 Jan 26.
[14]Coyne KS, Sexton CC,et al The prevalence of lower urinary tract symptoms (LUTS) in the USA, the UK and Sweden:results from the Epidemiology of LUTS (EpiLUTS) study. BJU Int.2009 Aug;104(3):352-60. Epub 2009 Mar 5
[15]Jittima Manonai, Aporn Poowapirom, et al Female urinary incontinence:a cross-sectional study from a Thai rural area. Int Urogynecol J(2006) 17:321-325
[16]Onur R, Deveci SE,et al Prevalence and risk factors of female urinary incontinence in eastern Turkey. Int J Urol.2009 Jun;16(6):566-9. Epub 2009 Apr 28
[17]Tozun M, Ayranci U, Unsal A. Prevalence of urinary incontinence among women and its impact on quality of life in a semirural area of Western Turkey. Gynecol Obstet Invest.2009;67(4):241-9. Epub 2009 Mar 24.
[18]El-Azab AS, Mohamed EM, Sabra HI. The prevalence and risk factors of urinary incontinence and its influence on the quality of life among Egyptian women. Neurourol Urodyn.2007;26(6):783-8.
[19]Lee KS, Sung HH, Na S, Choo MS. Prevalence of urinary incontinence in Korean women:results of a National Health Interview Survey. World J Urol.2008 Apr;26(2):179-85. Epub 2008 Feb 12.
[20]Wennberg AL, Molander U, Fall M, Edlund C, Peeker R, Milsom I. A longitudinal population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in women. Eur Urol.2009 Apr;55(4):783-91. Epub 2009 Jan 13.