目的:评估腹部子宫肌瘤切除术后的人群特征和产科并发症腹腔镜子宫肌瘤切除术.
方法:回顾性队列研究,使用医疗保健成本和利用项目全国住院患者样本,2004年至2014年期间出院。
方法:以人口为基础。
方法:13868和338例腹部或腹腔镜子宫肌瘤切除术后妊娠,分别。
方法:收集腹部和腹腔镜子宫肌瘤切除术后的产科结果。
方法:使用多元和二项逻辑回归,并在不同的年龄模型中进行调整,肥胖,慢性高血压,和孕前糖尿病。
方法:怀孕,delivery,并对新生儿结局进行分析。
结果:腹部子宫肌瘤切除术的特点是年轻患者,较低的高加索人,慢性高血压,孕前糖尿病,积极吸烟,非法药物使用,先前的剖宫产率更高,与腹腔镜子宫肌瘤切除术相比,多胎妊娠。腹腔镜子宫肌瘤切除术的孕妇妊娠高血压的发生率降低[调整后的风险比(aRR)0.12,95%置信区间(CI)0.006-0.24]。妊娠期高血压(ARR0.24,95CI0.08-0.76),先兆子痫(RR0.18,95CI0.07-0.48),和子痫前期或子痫叠加慢性高血压(RR0.03,95CI0.005-0.3),妊娠期糖尿病(RR0.14,95CI0.06-0.34),早产胎膜早破(RR0.14,95CI0.02-0.96),早产(ARR0.36,95CI0.23-0.55),和剖宫产(CD)(aRR0.01,95CI0.007-0.01)和小于胎龄(aRR0.15,95CI0.005-0.04),与开腹子宫肌瘤切除术组相比。腹腔镜下子宫肌瘤剔除组有较高的自发性ARR35.57,95CI22.53-62.66),和手术阴道分娩(aRR10.2,95CI8.3-12.56),子宫破裂(RR6.1。95CI3.2-11.63),产后出血(ARR3.54,95CI2.62-4.8),子宫切除术(aRR7.74,95CI5.27-11.4),输血(ARR3.34,95CI2.54-4.4),肺栓塞(aRR7.44,95CI2.44-22.71),弥散性血管内凝血(RR2.77,95%CI1.47-5.21),与腹部子宫肌瘤切除术组相比,母体感染(aRR1.66,95CI1.1-2.5)和死亡(aRR2.0495CI1.31-3.2))和子宫内胎儿死亡(aRR2.99,95CI1.72-5.2)。
结论:曾进行过腹部子宫肌瘤切除术的女性具有妊娠期高血压疾病和妊娠期糖尿病的潜在危险因素。接受腹腔镜子宫肌瘤切除术的女性出血风险更高,子宫破裂,由此产生的并发症,和死亡,应该作为高危患者进行监测,比如腹部子宫切除术.
OBJECTIVE: To evaluate population characteristics and obstetrical complications after abdominal myomectomy vs. laparoscopic myomectomy.
METHODS: Retrospective cohort study, using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, with hospital discharge between 2004 and 2014.
METHODS: Population-based.
METHODS: 13868 and 338 pregnancies following abdominal or laparoscopic myomectomy, respectively.
METHODS: Obstetrics outcomes following abdominal and laparoscopic myomectomy were collected.
METHODS: Multiple and Binomial logistic regression were used and adjusted in different models for age, obesity, chronic hypertension, and pre-gestational diabetes mellitus.
METHODS: Pregnancy, delivery, and neonatal outcomes were analyzed.
RESULTS: Abdominal myomectomy were characterized by younger patients, lower rates of Caucasian, chronic hypertension, pregestational diabetes, active smoking, illicit drug use, and higher rates of previous cesarean delivery, and multiple gestations when compared to laparoscopic myomectomy. Pregnant women with laparoscopic myomectomy had decreased rates of pregnancy-induced hypertension [adjusted risk ratios (aRR) 0.12, 95% confidence intervals (CI) 0.006-0.24)], gestational hypertension (aRR 0.24, 95%CI 0.08-0.76), preeclampsia (aRR 0.18, 95%CI 0.07-0.48), and preeclampsia or eclampsia superimposed on chronic hypertension (aRR 0.03, 95%CI 0.005-0.3), gestational diabetes mellitus (aRR 0.14, 95%CI 0.06-0.34), preterm premature rupture of membranes (aRR 0.14, 95%CI 0.02-0.96), preterm delivery (aRR 0.36, 95%CI 0.23-0.55), and cesarean delivery (CD) (aRR 0.01, 95%CI 0.007-0.01) and small for gestational age (aRR 0.15, 95%CI 0.005-0.04), compared to abdominal myomectomy group. Laparoscopic myomectomy group had a higher rate of spontaneous aRR 35.57, 95%CI 22.53-62.66), and operative vaginal delivery (aRR 10.2, 95%CI 8.3-12.56), uterine rupture (aRR 6.1. 95%CI 3.2-11.63), postpartum hemorrhage (aRR 3.54, 95%CI 2.62-4.8), hysterectomy (aRR 7.74, 95%CI 5.27-11.4), transfusion (aRR 3.34, 95%CI 2.54-4.4), pulmonary embolism (aRR 7.44, 95%CI 2.44-22.71), disseminated intravascular coagulation (aRR 2.77, 95% CI 1.47-5.21), maternal infection (aRR 1.66, 95%CI 1.1-2.5) and death (aRR 2.04 95%CI 1.31-3.2)) and intra-uterine fetal death (aRR 2.99, 95%CI 1.72-5.2) compared to the abdominal myomectomy group.
CONCLUSIONS: Women who had a previous abdominal myomectomy have underlying risk factors for hypertension disorders of pregnancy and gestational diabetes. Women who underwent laparoscopic myomectomies have higher risks of bleeding, uterine rupture, resultant complications, and death, and should be monitored as high-risk patients, like abdominal myomectomies.