妊娠期与非妊娠期子宫肌瘤红色变性的临床分析

Clinical analysis of red degeneration of uterine leiomyoma in patients with and without pregnancy

目的:研究妊娠期与非妊娠期子宫肌瘤红色变性的临床特征及发生机制。方法:回顾分析1997年1月～2005年12月行子宫肌瘤切除术的住院病例资料。结果:妊娠期与非妊娠期子宫肌瘤分别有34例和42例发生红色变性,分别占妊娠期、非妊娠期子宫肌瘤的15.74%和1.39%,差异有统计学意义(P<0.001),变性肌瘤剧烈腹痛(妊娠期2.94%,非妊娠期21.43%)差异有统计学意义(P<0.05),子宫体压痛(妊娠期35.3%,非妊娠期66.7%)、发热(妊娠期5.9%,非妊娠期3l%),两组间差异均有统计学意义(P<0.01),妊娠期变性肌瘤64.7%位于浆膜下,非妊娠期变性肌瘤83.3%位于肌壁间,差异有统计学意义(P<0.001),红色变性肌瘤直径妊娠组〔(4.74±2.8)cm〕明显小于非妊娠组〔(6.9±3.7)cm〕,差异有统计学意义(P<0.01)。结论:妊娠期子宫肌瘤红色变性的发生率明显高于非妊娠期,且临床症状较轻,其发生机制可能与肌瘤部位、大小、妊娠期易栓症状态及肌瘤变性演变进程有关。

Objective： To compare the clinical features of red degeneration of uterine leiomyoma between pregnancy and non - pregnancy, as well as study the etiology of the red degeneration. Methods： The data of 76 cases of uterine leiomyoma with red degeneration underwent myomectomy in this hospital during Jan 1997 - Nov 2005 were studied retrospectively. Results： The red degeneration of uterine leiomyoma existed among pregnancy and non - pregnancy were 34 cases （ 15. 74% ） and 42 cases （ 1. 39% ） respectively （P 〈0. 001 ）. Among those patients with and without pregnancy, difference of incidence rate was observed in severe low abdominal pain （2. 94% vs 21. 43% ） （P 〈 0. 05 ）, oppressing pain in the uterine （35. 3 % vs 66. 7% ） and fever （5. 9% vs 31% ） （P 〈 0. 01 ） . For patients with pregnancy, 64. 7% of myoma with red degenation were subserous myomas, but for those without pregnancy, 83.3 % were intramural myomas （P 〈0. 001 ） . The diametre or largest myoma in those with pregnancy were smaller than those without pregnancy, being （4. 7 ±2. 8） cm and （6. 9 ±3.7） cm respectively （P 〈0. 01 ） . All the red degeneration developed in the largest myoma. Conclusion： Uterine leiomyoma in pregnancy patients have more frequent red degeneration but less symptoms, this may be associated with thrombophilia during pregnancy, the different volume and position of myoma, and the procedure of red degeneration of uterine ieiomyoma between pregnancy and non - pregnancy.