妊娠合并子宫多发肌瘤剖宫产术中处理方案研究

Research on diagnosis and treatment of pregnancy complicated with multiple uterine myoma during cesarean section

目的探讨妊娠合并子宫多发肌瘤的剖宫产术中最佳的处理方案。方法收集2009年1月-2014年1月在本院住院的剖宫产妊娠合并子宫多发肌瘤病例196例,术中行单纯剖宫产术34例,剖宫产同时行子宫多发肌瘤剥除术130例,剖宫产同时行子宫次全切除术32例,比较3组的年龄、手术时间、术中及术后出血量、住院天数及产褥感染发生率等。结果 3组术中出血量、住院天数、产褥感染发生率比较差异无统计学意义（P〉0.05）;剖宫产同时行子宫次全切除术组的年龄较其他两组大（P〈0.05）;单纯性剖宫产术组手术时间较其他两组短（P〈0.05）;单纯性剖宫产组及同时行子宫多发肌瘤剥除术组术后24 h出血量较同时行次全切除术组多（P〈0.05）。结论妊娠合并子宫多发肌瘤剖宫产术中手术方式不固定,应根据肌瘤的大小、位置及患者的生育要求等情况决定最佳方案。

Objective To explore the best treatment scheme of pregnancy complicated with uterine multiple myoma during cesarean section. Methods 196 cases about cesarean section pregnancy complicated with multiple uterine fibroids in our hospital from January 2009 to January 2014 were collected.Among those cases,intraoperative simple cesarean section was used in 34 cases,cesarean section and uterine curettage stripping multiple myoma were applied in130 cases,cesarean section and subtotal hysterectomy were used in 32 cases.The age,operation time,intraoperative and postoperative bleeding,hospital stay and incidence rate of puerperal morbidity in three groups were compared. Results Intraoperative bleeding,hospital stay and incidence rate of puerperal morbidity in three groups was compared respectively,with no statistical difference（P〉0.05）.The age of cesarean section and subtotal hysterectomy group was older than that of other two groups respectively（P〈0.05）.Operation time of simple cesarean section group was shorter than that of other two groups respectively（P〈0.05）.Postoperative bleeding of 24 hours in simple cesarean section group and cesarean section and uterine curettage stripping multiple myoma group was more than that in cesarean section and subtotal hysterectomy group respectively（P〈0.05）. Conclusion Operation mode about pregnancy complicated with multiple uterine fibroids in cesarean section is not sure,the optimal scheme should be determined based on the size and location of myoma,patient′s birth requirement.