剖宫产术中子宫肌瘤剔除56例分析

Cesarean section uterine myomectomy:analysis of 56 cases

目的探索妊娠合并子宫肌瘤时行剖宫产术同时行子宫肌瘤剔除术的手术指征,并分析其临床可行性意义及手术的安全性。方法选取我院妇产科从2013年8月~2014年7月期间收治入院的妊娠合并子宫肌瘤行剖宫产术中子宫肌瘤剔除者56例为观察组,同时随机抽取同一时间段行单纯子宫下段剖宫产术无子宫肌瘤合并症的产妇56例为对照组,观察并分析两组产妇手术前后中的四项基本生命体征、相关实验室检查结果、术中出血量、手术时间及术后的临床表现有无差异。结果术中及术后两组产妇的出血发生率分别为观察组12.33%,对照组11.21%,两组差异无统计学意义（P〉0 05）;两组产妇的催产素使用量、手术前后发热率及血红蛋白值、红细胞压积、术后恶露持续时间、肛门通气及住院时间相比,差异无统计学意义（P〉0 05）;观察组剖宫术同时行子宫肌瘤剔除术时间比对照组长,两组手术时间对比,差异有统计学意义（P〈0.05）;子宫肌瘤分为单发和多发、浆膜下和肌壁间,不同部位、大小不同的子宫肌瘤剔除后,术中出血量差异有统计学意义（P〈0.05）。所有产妇伤口愈合良好,均无产后并发症发生。结论当子宫肌瘤≤5cm时,行剖宫产手术并子宫肌瘤剔除术,不仅可以减轻患者再次手术的医疗费用及手术的痛苦,而且该手术方案安全可行,并没有因合并子宫肌瘤剔除术而增加手术风险。但当子宫肌瘤位于子宫下段且直径〉5cm时,手术风险较大,不推荐临床行剖宫产合并子宫肌瘤剔除术。

Objective To explore the combined with uterine leiomyoma were cesarean section pregnancy al- so for uterine myoma myomectomy operation indications, safetyand to analyze its clinical significance and the feasibility of operation. Methods in our hospital from 2013 August to 2014 in the Department of Obstet-rics and Gynecology July admitted to pregnant women with uterine myoma during cesarean section withuter- ine fibroids in 56 cases as the observation group, maternal also selected randomly from the same time period for simple lower uterine cesarean section withoututerine myoma in 56 cases as control group there is no dif- ference, observation and analysis of two groups of puerperas before operation four basic vital signs, bleeding after the inspection results, related laboratory intraoperative volume, operation timeand postoperative clinical manifestation. Results of intraoperative andpostoperative bleeding of the two groups occurred in the obser- vation group 12.33%, control group 11.21%, with no significant difference between two groups （P〉0.05）; The two groups before and after the operation the amount of use of oxytocin,heatingrate and hemoglobin, hematocrit, lochia duration, postoperative anus ventilation and hospitalization time were compared, the dif- ference was not statistically significant（P〉0.05 ） ;Observation group cesarean section at the same time for u- terine myomamyomectomy time longer than the control group, two groups of operation time comparison,the difference was statistically significant （P〈0.05）;Myoma of uterus is divided into single and multiple, sub- serous and muscular wall of the uterus, myomectomy of different size, different positions, have significant difference in theamount of bleeding during （P〈0.05）. All women the wound healed well,no postpartumcom- plications. Conclusions when the myoma of uterus is less than or equal to 5cm, cesarean section operation and myomectomy, can not only reduce the medical cost and operation again operation in patients with pain, and the operation scheme is safe and feasible, and not because of complicated with uterine myomectomy and increase the operation risk. But when the leiomyoma is located in the lower uterine segmentand the diameter of 〉5cm, operation risk, not recommended clinical cesarean sectioncombined with uterine myomectomy.