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Title: [Application of DDI in prediction of fertility outcome after laparoscopic myomectomy].
Author: Liang XX, Zhang ZY, Liu CD, Qu H.
Journal: Zhonghua Fu Chan Ke Za Zhi; 2018 Aug 25; 53(8):528-533. PubMed ID: 30138962.
Abstract:
Objective: To analyze the application of difficulty degree index (DDI) in predicting patients's fertility outcome after laparoscopic myomectomy. Methods: A retrospective study was carried out on 118 patients with subserous myoma or intramural myoma undergoing laparoscopic myomectomy from January 2005 to December 2014. The rate of post-operative pregnancy, delivery outcome and disease recurrence were investigated. Logistic regression analysis was used to analyze the impact of DDI, the age of patients undergoing surgery, presence of infertility history etc, on the patients' reproductive outcome following the surgery. Results: Follow-up for 1 to 10 years,118 cases were included in the study, the rate of post-operative pregnancy, live birth, vaginal delivery were 72.9% (86/118) , 52.5% (62/118) and 24.2% (15/62) respectively. No cases of uterine rupture and obstetric complications occurred. Univariate analysis showed that the independent variables of post-operative pregnancy rate were DDI, patient's age at the time of surgery, presence of infertility history and myoma recurrence (all P<0.05) . In multivariate analysis, the factors of post-operative pregnancy rate were DDI (OR=3.131, 95%CI:1.012-8.894) , patient's age at the time of surgery (OR=2.722, 95%CI:1.048-7.067) and presence of infertility history (OR=8.509, 95%CI: 2.102-34.445) . Conclusions: DDI could be applied to predict post-operative pregnancy rate, with the increasing of DDI the post-operative pregnancy rate decreasing. The patients with high DDI scores, age>35 years old or presence of infertility history should get ready for pregnancy positively. 目的： 分析"子宫肌瘤腹腔镜剔除术手术难度评分系统（DDI）"在预测子宫肌瘤剔除术后自然妊娠结局中的应用价值。 方法： 回顾性分析2005年1月1日—2014年12月31日期间首都医科大学附属北京朝阳医院118例因浆膜下或肌壁间子宫肌瘤行腹腔镜子宫肌瘤剔除术患者的临床病理资料，随访术后自然妊娠结局、肌瘤复发情况，采用logistic回归分析DDI评分、年龄、不孕症病史、肌瘤复发等因素对术后自然妊娠结局的影响。 结果： 随访1~10年，共入组118例患者，术后自然妊娠率为72.9%（86/118），活产率为52.5%（62/118），阴道分娩率为24.2%（15/62），无子宫破裂发生。单因素分析结果显示，影响术后自然妊娠率的因素包括DDI评分、年龄、术前不孕症病史、肌瘤复发（P<0.05）。多因素logistic回归分析结果显示，影响术后自然妊娠率的影响因素是DDI评分（OR=3.131，95%CI为1.012~8.894）、年龄（OR=2.722，95%CI为1.048~7.067）和术前不孕症病史（OR=8.509，95%CI为2.102~34.445）。 结论： DDI评分系统作为手术特点的重要指标可用于腹腔镜子宫肌瘤剔除术后自然妊娠率的预测，术后自然妊娠率随DDI评分增加而下降；建议DDI评分高、年龄>35岁、术前有不孕症病史的患者术后积极备孕。.

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