聚焦超声消融手术治疗子宫肌瘤妊娠结局及影响因素分析OA北大核心CSTPCD

Objective To study the pregnancy outcomes in patients with uterine fibroids who desire future fertility after focused ultrasound ablation surgery(FUAS)and further analyze factors influencing pregnancy outcomes.Methods A to-tal of 892 patients with uterine fibroids who desired future fertility and received FUAS treatment at Chongqing Haifu Hos-pital from April 2011 to December 2022 were retrospectively analyzed.Pregnancy outcomes were followed up and factors affecting pregnancy outcomes were analyzed through multivariate analysis.Results Among the 892 patients,113 pa-tients who were unmarried or divorced,and 82 patients who were lost to follow-up within 6 months after the procedure were excluded.Finally,697 patients were enrolled.(1)Among them,283 patients were pregnant at a median of 6.0(3.0,10.0)months after FUAS,with a total of 288 pregnancies,and the post-FUAS pregnancy rate was 40.6％(283/697).(2)Among the 283 pregnant patients,69(24.4％)had a history of adverse pregnancy,and 51(18.0％)were infertile.(3)At the end of follow-up(October 2023),256 patients had 261 times of successful deliveries,11 patients were still in preg-nancy,and 16 patients had miscarriage.(4)None of the 283 patients had a uterine rupture during pregnancy or delivery.Among the 256 patients who had given birth,only 14(5.5％)patients suffered from postpartum complications.(5)Of the 262 newborns(1 twins),11 suffered from neonatal asphyxia,of whom 1 case of Fallot's tetralogy underwent elective sur-gery,while the other infants were doing well.(6)Statistical analysis showed a significant difference in age,type of fi-broids,number of fibroids,non-perfused volume(NPV)and NPV ratio between the group of pregnant patients and the group of non-pregnant patients(P＜0.05).(7)A sig-nificant differences in number of fibroids,NPV and NPV ratio were also observed between patients in normal deliv-ery group and the miscarriage group(P＜0.05).Conclusions FUAS is a safe and effective treatment for patients with uterine fibroids who wish to conceive.The time to conception after FUAS is short,and the pregnancy outcomes are im-proved,which does not affect the delivery or increase obstetric risks.The older age,multiple fibroids,submucosal fi-broids,the limited NPV and the low NPV ratio have negative effects on pregnancy.The main factors influencing pregnan-cy outcome are the number of fibroids,NPV and NPV ratio.