肌壁间肌瘤患者长效与短效长方案促排卵过程及效果比较-东南大学学报医学版

肌壁间肌瘤患者长效与短效长方案促排卵过程及效果比较

单位：南京大学医学院附属鼓楼医院生殖医学中心, 江苏南京 210008

分类号：R737.33

出版年·卷·期（页码）：2018·37·第三期（396-400）

摘要：

目的：探索更适合宫腔形态正常的肌壁间肌瘤患者的辅助生育促排卵方案。方法：回顾性分析体外受精胚胎移植/卵胞浆内单精子注射技术（IVF/ICSI）助孕的肌壁间肌瘤病例的临床资料；根据手术史、肌瘤大小及数目分为肌瘤术后组、肌瘤直径<2 cm组、肌瘤直径≥ 2 cm组及多发性肌瘤组4组，再按降调节药物分为长效亚组（A亚组）及短效亚组（B亚组），对促排卵过程及妊娠结局进行比较。结果：肌瘤直径<2 cm组及多发性肌瘤组中，促性腺激素（Gn）用量A亚组均显著高于B亚组。A亚组着床率有大于B亚组趋势，但仅在肌瘤直径<2 cm组差异有统计学意义。各组的长效亚组相比，多发性肌瘤A亚组和肌瘤≥ 2 cm A亚组胚胎着床率低于肌瘤术后A亚组及肌瘤<2 cm A亚组，但仅在多发性肌瘤A亚组差异有统计学意义。结论：较大的或多发性肌壁间肌瘤可能对生育功能仍有不利影响，这些患者若不愿接受手术治疗，而是直接进行辅助生育治疗，则可优先考虑长效长方案。

Objective: To explore a more suitable ovulation induction of assisted reproductive therapy for patients with intramural myoma without affecting the shape of uterus.Methods: The clinical data of patients with intramural myoma receiving in vitro fertilization and embryo transfer/intracytoplasmic sperm injection(IVF/ICSI) were retrospectively analyzed. According to operation history, the size and number of fibroids, they were divided into four groups:postoperative group, myoma diameter<2 cm group, myoma diameter ≥ 2 cm group and multiple myoma group. The groups were further divided into long-acting subgroup(A subgroup) and short-acting subgroup(B subgroup) in accordance with down-regulation agents. The ovulation induction process and pregnancy outcome were compared among the patients in each group.Results: In the myoma diameter<2 cm group and multiple myoma group, the dosage of Gn used in subgroup A was significantly higher than that in subgroup B. The rate of implantation in subgroup A was higher than that in subgroup B. Statistically significant difference was only found in the myoma diameter<2 cm group. Compared with the long-acting subgroups of each group, the implantation rate of the multiple myoma A subgroup and the myoma ≥ 2 cm A subgroup was lower than that of the postoperative A subgroup and the myoma <2 cm A subgroup. But only in the multiple myoma A subgroup there were statistical differences.Conclusion: Larger or multiple intramural fibroids may have adverse effects on reproductive function. If these patients do not want to undergo surgery and want directly to receive assisted fertility therapy, long-acting GnRH-a protocols may be preferentially considered.

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