子宫肌瘤/腺肌瘤剔除术后妊娠子宫破裂的临床研究

Clinical analysis of uterine rupture during pregnancy after previous myomectomy/adenomyomectomy

目的探讨子宫肌瘤/腺肌瘤剔除术后妊娠子宫破裂的临床特点及预防。方法对1990年1月至2014年6月北京协和医院收治的子宫肌瘤/腺肌瘤剔除术后妊娠子宫破裂的病例进行回顾性分析。结果共有599例患者子宫肌瘤/腺肌瘤剔除术后妊娠,其中6例发生子宫肌瘤/腺肌瘤剔除术后妊娠子宫破裂,术后妊娠子宫破裂的发生率为1.00%,其中腹腔镜下肌瘤剔除术后妊娠子宫破裂的发生率为1.20%(5/415),开腹剔除术后妊娠子宫破裂的发生率为0.54%(1/184)。结论子宫肌瘤/腺肌瘤剔除术史是妊娠子宫破裂的高危因素;与开腹手术相比,腹腔镜下子宫肌瘤/腺肌瘤剔除术后妊娠子宫破裂的发生率有增高的趋势。

Objective：To analyze the clinical characteristics and preventive measures of uterine rupture during pregnancy after previous myomectomy/adenomyomectomy.Methods：The data of patients with uterine rupture after previous myomectomy/adenomyomectomy from January 1990 to June 2014 in Peking Union Medical Collage Hospital were analyzed retrospectively.Results：A total of 599 patients were pregnant after myomectomy/adenomyomectomy.Among them,6patients were diagnosed with uterine rupture during the pregnancy.The rate of uterine rupture was1.00%.The rate of uterine rupture during the pregnancy after the laparoscopic myomectomy/adenomyomectomy was 1.20%（5/415）,while the rate of uterine rupture during pregnancy after the laparotomy myomectomy was 0.54%（1/184）.Conclusions：A history of previous myomectomy/adenomyomectomy is a high risk factor of uterine rupture during pregnancy.The rate of uterine rupture during pregnancy after the laparoscopic myomectomy/adenomyomectomy is higher than that after the laparotomy myomectomy