子宫肌瘤手术治疗362例分析

PROBLEMS IN SURGLCAL TREATMENT OF HYSTEROMYOMA

对１９８５～１９９２年经手术及病理证实的子宫肌瘤３６２例进行分析。其中１例肉瘤变，恶变率０．３％；手术并发症６例，其中膀胱损伤、输尿管损伤、阴道断端出血各２例（占１．７％）。认为对有剖宫产史者要注意预防膀胱损伤；输尿管损伤多发生于宫颈肌瘤；阴道断端出血多发生于合并阴道炎症者，术后随访发现保留卵巢者未发生更年期症状；而全子宫双附件切除者，术后５～３０ｄ均出现更年期综合征。主张绝经前行手术者尽量保留正常卵巢。

cases with hysteromyoma from 1985 to 1992 were analysed.All of themwere comfirmed both by operation and pathological examination. Among them,1 case waswith sarcomatous change(0.3%).Operative complications were occurred in 6 cases(1.7%)including bladder injury 2,ureter injury 2,bleeding of vaginal incision 2. For pa-tients with previous caesarean section,proper dissection of bladder could prevent bladderinjury. Before clamping and cutting uterine arteries,enucleating cervical myoma and re-suming its normal anatomical position were very important for reducing ureter injury.Treating vaginal inflammation before operation and sewing incision carefully could elimi-nate postoperative bleeding. Menopausal syndrome was occurred within 5～30 days posthysterectomy and bilateral ovariotomy,but not occurred in those with the ovary reserved.The author suggested that it is necessary to reserve normal ovary in the premenopausalpatients.