199例晚期妊娠合并子宫肌瘤患者的临床特点分析

Clinical characteristics of 199 cases of late pregnancy and uterine hysteromyoma

目的：探讨晚期妊娠合并子宫肌瘤的临床特点。方法：回顾性分析2010年6月至2015年12月河源市龙川妇幼保健院收治的199例晚期妊娠合并子宫肌瘤孕妇的临床资料，统计子宫肌瘤诊断情况、妊娠期并发症、子宫肌瘤特性、分娩方式等。按剖宫产术中是否剔除肌瘤分为未剔除组（单纯剖宫产术）和剔除组（剖宫产并肌瘤剔除术）；按肌瘤最大径分为≥5 cm组和＜5 cm组，比较两组手术时间、术中出血量、首次肛门排气时间、住院时间等。结果：术前诊断137例（68．8％）、剖宫产术中诊断62例（31．2％）；经阴道分娩32例，产程顺利。未剔除组（63例）和剔除组（103例患者）均顺利完成剖宫产术，两组手术时间比较，差异有统计学意义（P＜0．05）。103例剔除组患者肌瘤最大径为0．5～10．0 cm，剔除的最大子宫肌瘤为l0 cm×10 cm ×8 cm。≥5 cm组（27例）术中出血量较＜5 cm组（76例）增多（P＜0．05）。结论：对于妊娠合并子宫肌瘤患者，需尽早明确诊断，选择合适的分娩方式和治疗方法；当子宫肌瘤体积较大时，应酌情采取合理方式，选择剖宫产同时行肌瘤剔除安全可行。

Objective：To investigate the clinical characteristics of late pregnancy and uterine hysteromyoma. Methods：The clinical data of 199 pregnant women with late pregnancy and uterine hysteromyoma,who were hospitalized in Longchuan Maternal and Child Health Hospital between June 2010 and December 2015,were retrospectively analyzed. The diagnosis of uterine hysteromyoma,pregnancy complications,charactersistics of uterine hysteromyoma,and mode of delivery were statistically analyzed. According to whether the hysteromyoma were removed in Cesarean section,all patients were divided into the hysteromyoma group （simple Cesarean section）and the hysteromyoma removed group （Cesarean section and myomectomy）. According to the maximum diameter of the hysteromyoma,all patients were divided into hysteromyoma ≥5 cm group and〈5 cm group. The operative time,intraoperative blood loss,first flatus time and hospital stay in the two groups were compared. Results：A total of 137 cases （68. 8%）and 62 cases （31. 2%）were diagnosed with hysteromyoma before and during the Cesarean section,respectively. There were 32 cases of vaginal delivery,with successful labor process. Both of the hysteromyoma group （n= 63 ） and the hysteromyoma removed group （n= 103 ） underwent the Cesarean section successfully. There was statistically significant difference in the operative time between the two groups （P〈0.05）. In 103 cases of the hysteromyoma removed group,the maximum diameter of hysteromyoma was 0.5~10.0 cm,and the removed maximum volume of hysteromyoma was l0 cm×10 cm×8 cm. The intraoperative blood loss was increased in the hysteromyoma ≥5 cm group （n=27）compared with that in the hysteromyoma 〈5 cm group （n=76）（P〈0.05）. Conclusion：Pregnant patients with hysteromyoma should be diagnosed as early as possible with appropriate delivery mode and treatment. When the volume of the hysteromyoma is large, appropriate treatment should be taken into consideration. Treating with Cesarean section and myomectomy is feasible and safe.