30例剖宫产术中子宫肌瘤切除术临床分析

Clinical Observation of Myomectomy and Cesarean Section at Same Operation in 30 Cases

目的:观察剖宫产术中子宫肌瘤切除术的临床疗效和安全性,评价其临床应用效果,为临床治疗提供参考和借鉴。方法:回顾性分析2008年11月至2013年11月我院行剖宫产术加子宫肌瘤切除术的30例产妇(观察组)的临床资料,并与同期行剖宫产术的105例产妇(对照组)进行对比分析,比较2组产妇的手术时间、术中出血量、术后出血量、术后住院时间、术后出血率、术后感染率、产后42 d子宫复旧率。结果:观察组患者手术时间为58.2±9.7 min,对照组患者手术时间为37.9±8.2 min,2组比较有显著性差异(t=2.251 8,P<0.05)。但2组产妇在术中出血量、术后出血量、术后住院时间、术后出血率、术后感染率、产后42 d子宫复旧率等方面比较无显著性差异(P>0.05)。结论:在严格掌握手术指征、术中病情精准判断、灵活处理应激事件基础之上,于剖宫产术中行子宫肌瘤切除术,能有效地控制产妇术中出血量、术后出血量、感染率,避免产妇行再次手术的痛苦,缩短疗程,减少治疗费用,疗效显著且安全性高,值得在临床上广泛应用和推广。

Objective：To observe the clinical efficacy and safety of myomectomy and cesarean section at same aoperation,and to provide a reference for the future clinical treatment. Methods：Analyzed retrospectively the clinical data of 30 puerpera cases（ the observation group） who were performed with cesarean section and myomectomy from November 2008 to November 2013,and were compared with 105 puerpera cases（the control group） who were only performed with cesarean section in the same period in the operation time,intraoperative blood loss,postoperative blood loss,postoperative hospital stay,postoperative bleeding rate,postoperative infection rate,postpartum 42 d uterine involution rate. Results：The operation time of the observation group was58. 2 ± 9. 7 min which was longer than that（37. 9 ± 8. 2 min） of the control group（ t = 2. 251 8,P〈0. 05）.The difference had statistically significant. However,the comparisons in intraoperative blood loss,postoperative blood loss,postoperative hospital stay,postoperative bleeding rate,postoperative infection rate,postpartum42 d uterine involution rate in the two groups had not statistical differences（P〈0. 05）. Conclusion：Basing on surgical indications strictly, judging intraoperative condition accurately and handling emergency events flexiblely,performing myomectomy and cesarean section at same operation can control the the maternal intraoperative blood loss,postoperative blood loss and infection rate effectively. It can avoid a second operation. It can shorten the course of treatment and reduce the cost. Its curative effect are significant and safe. It is worthy to be applyed and promoted widely in clinical practice.