不同子宫肌瘤类型合并妊娠的分娩方式选择

The options of childbirth mode for the patients with pregnancy and different types uterine fibroids

目的探讨不同子宫肌瘤类型合并妊娠分娩方式选择,提高手术治疗效果。方法回顾性分析自2001年3月至2010年5月收治的150例妊娠合并子宫肌瘤患者的临床资料,按照不同子宫肌瘤类型结合产科情况选择分娩方式,对手术情况、产后出血量等方面进行探讨。结果①合并浆膜下肌瘤组阴道分娩方式较剖宫产术中出血量少,但差异无统计学意义(P>0.05),合并肌壁间肌瘤、多发性肌瘤组阴道分娩方式均较剖宫产术中出血量多,差异有统计学意义(P<0.01)。三组患者阴道分娩时间均较剖宫产手术长(P<0.01)。②合并浆膜下肌瘤组两种分娩方式比较术后出血量差异不大(P>0.05);合并肌壁间肌瘤组两种分娩方式比较术后出血量差异显著(P<0.01)。③三种分娩方式中以单纯剖宫产复发率最高(34.93%),剖宫产联合子宫肌瘤剔除术复发率最低(7.35%)。阴道分娩与剖宫产复发率比较差异不大(P>0.05),剖宫产联合子宫肌瘤剔除术与前两者比较差异显著(P<0.01)。结论根据不同子宫肌瘤类型选择不同分娩方式可降低手术创伤、术后出血量,有利于产妇康复及子宫肌瘤治愈。

Objective To investigate the different types of uterine myoma with pregnancy childbirth way selection, improve the opera- tion effect of treatment. Methods Retrospective analysis of our hospital from 2001 March to 2010 May, 60 cases of pregnancy complicated with uterine myoma patients with the clinical data, according to different types of uterine leiomyoma with obstetric case choose the way of delivery, the operation condition, the amount of postpartum hemorrhage were discussed. Results （1）With subserous myoma group than vaginal delivery in cesarean section hemorrhage less, but without statistical significance （ P 〉 0.05 ）, with intramural fibroids, multiple fibroids was a group of vaginal delivery in cesarean section bleeding more （ P 〈 0.01 ） , with the statistical significance. The operation time of vaginal delivery was lon- ger than cesarean operation in the three groups with a statistical difference （ P 〈 0.01 ）. （2）With subserous myoma group two childbirth way comparison difference （ P 〉 0.05 ） ; with intramural myoma group two childbirth way marked difference （ P 〈 0.01 ）. （3）Three kinds of mode of delivery in order to simple cesarean section （ highest relapse rate 34.93% ）, followed by cesarean section combined with uterine myomectomy lowest recurrence rate （ 7.35 % ）. Vaginal delivery and cesarean section rate of recurrence compared difference （ P 〉 0.05 ）, cesarean section combined with uterine myomectomy and before both marked difference （ P 〈 0.01 ）. Conclusion According to different types of uterine leio- myoma of choosing different delivery mode can reduce the operation trauma, postoperative bleeding volume in favor of the maternal uterine fi- broids and rehabilitation.