剖宫产术中挤压法子宫肌瘤剔除与无肌瘤剖宫产的比较研究

Application of Myomectomy by Extrusion During Cesarean Sections

目的：通过与无肌瘤剖宫产对比，评价剖宫产术中挤压法子宫肌瘤剔除的安全性。方法2008年1月～2010年12月，剖宫产术中挤压法剔除子宫肌瘤128例（肌瘤组），选择肌瘤组病例的后一例无子宫肌瘤剖宫产为对照组128例。比较2组产后出血量、产后出血率、产后发热及术后住院时间。结果2组产后出血量[（233．6±58．9） ml vs．（228．5±90．9）ml， t＝0．530， P＝0．597]，出血率[0％（0/128） vs．0．8％（1/128）， P＝1．000]，血红蛋白下降[（6．17±2．83） g/L vs．（6.89±3．09）g/L， t＝-1．944， P＝0．053]，红细胞压积下降（2．22％±0．98％ vs．2．27％±1．02％， t＝-0．400， P＝0．690），发热率[2．3％（3/128） vs．5．5％（7/128），χ2＝1．665， P＝0．197]及术后住院时间[（4．2±0．8）d vs．（4．1±1．2） d， t＝0．706， P＝0.481]差异均无显著性。结论剖宫产术中挤压法剔除子宫肌瘤，不增加产后出血，也不增加产后感染，是一种简单、微创、安全、可行的手术方法，值得临床推广。

Objective To evaluate the safety of myomectomy by extrusion in cesarean section , in comparison with routine cesarean delivery. Methods From January 2008 to December 2010, a total of 128 operations of myomectomy by extrusion in cesarean section were performed （Myoma Group）, while another group of 128 cases undergoing caesarean section , which respectively followed every cases of the Myoma Group but had no hysteromyoma , was selected as the control group .The amount and rate of postpartum hemorrhage , the level of postpartum fever , and postoperative hospital stay between the two groups were compared , respectively. Results In the two groups：the amount of postpartum hemorrhage was （233.6 ±58.9） ml vs.（228.5 ±90.9） ml （t=0.530, P=0.597）; the rate of postpartum hemorrhage was 0% （0/128） vs.0.8% （1/128） （P=1.000）; the decrease of haemoglobin was （6.17 ±2.83） g/L vs.（6.89 ±3.09） g/L （t=-1.944, P=0.053）; the decrease of hematocrit was 2.22%± 0.98%vs.2.27%±1.02% （t=-0.400, P=0.690）; the rate of postpartum fever was 2.3% （3/128） vs.5.5% （7/128） （χ2 =1.665, P=0.197）;the length of postoperative hospital stay was （4.2 ±0.8） d vs.（4.1 ±1.2） d （t=0.706, P=0.481）. There were no significant differences between the two groups in the abovementioned parameters . Conclusions The myomectomy by extrusion in cesarean section does not increase the level of postpartum hemorrhage and the rate of postpartum infections .It is a simple, minimally invasive , safe and feasible surgical method , being worthy of clinical application .