双胎妊娠合并肌壁间子宫肌瘤孕妇剖宫产术时行肌瘤剔除术的安全性分析

Safety analysis of cesarean myomectomy in twin pregnancies with intramural myomas

目的评估双胎妊娠合并肌壁间子宫肌瘤孕妇剖宫产术时行肌瘤剔除术的安全性。方法收集在首都医科大学附属北京妇产医院产前检查并于2013年6月至2021年12月剖宫产术分娩的145例双胎妊娠合并肌壁间肌瘤孕妇的临床资料,比较剖宫产术时行子宫肌瘤剔除术(剔除组,49例)与单纯剖宫产术未行子宫肌瘤剔除术(未剔除组,96例)孕妇的一般特征、子宫肌瘤特征及母儿结局。结果与未剔除组相比,剔除组孕妇的手术时间显著延长[50.0 min(37.5~57.5 min)与40.0 min(35.0~50.0 min),P=0.007]、术后住院时间显著延长[4.0 d(3.0~4.0 d)与3.0 d(3.0~4.0 d),P=0.047];其他母儿结局,包括术中出血量、手术前后血红蛋白差值、产后出血、输血、B-Lynch缝合、子宫动脉结扎、术后发热的发生率以及新生儿Apgar评分分别比较,均无显著差异(P均>0.05)。对于最大径<5 cm的肌壁间肌瘤,母儿结局在剔除组与未剔除组之间无明显差异(P均>0.05)。对于最大径≥5 cm的肌壁间肌瘤,剔除组较未剔除组的手术时间显著延长[分别为55.0 min(40.0~60.0 min)与42.5 min(40.0~50.0 min),P=0.019]、术后住院时间明显延长[分别为4.0 d(4.0~5.0 d)与4.0 d(3.0~4.0 d),P=0.048],而两组间其他母儿结局分别比较均无显著差异(P均>0.05)。结论对于双胎妊娠合并肌壁间子宫肌瘤孕妇,由经验丰富的妇产科医师在剖宫产术时剔除肌壁间肌瘤是安全可行的。

Objective To estimate the safety of myomectomy in twin pregnant women with intramural myomas during cesarean section.Methods The clinical data of 145 cases of twin pregnancies with intramural myomas who were delivered by cesarean section in Beijing Obstetrics and Gynecology Hospital,Capital Medical University from June 2013 to December 2021 were collected.Maternal demographics,fibroids′characteristics,maternal and fetal outcomes were compared between groups of cesarean section with myomectomy(myomectomy group,49 cases)and cesarean section only(non-myomectomy group,96 cases).Results Compared with non-myomectomy group,myomectomy group had significantly prolonged operative time[50.0 minutes(37.5-57.5 minutes)vs 40.0 minutes(35.0-50.0 minutes),respectively;P=0.007]and significantly longer postoperative hospital stay[4.0 days(3.0-4.0 days)vs 3.0 days(3.0-4.0 days),respectively;P=0.047].Other maternal and fetal outcomes such as estimated blood loss,hemoglobin difference,postpartum hemorrhage,blood transfusion,B-Lynch structure,uterine artery ligation,postoperative fever and neonatal Apgar score showed no significant differences(all P>0.05).For intramural myomas<5 cm,there were no significant differences in maternal and fetal outcomes between myomectomy group and non-myomectomy group(all P>0.05).For intramural myomas≥5 cm,operative time[55.0 minutes(40.0-60.0 minutes)vs 42.5 minutes(40.0-50.0 minutes),respectively;P=0.019]was significantly prolonged,postoperative hospital stay[4.0 days(4.0-5.0 days)vs 4.0 days(3.0-4.0 days),respectively;P=0.048]was significantly longer in myomectomy group than non-myomectomy group,but there were no significant differences in other maternal and fetal outcomes(all P>0.05).Conclusion For twin pregnancies with intramural myomas,it is safe and feasible to remove intramural myomas during cesarean section by experienced obstetricians.