妊娠合并子宫肌瘤71例临床分析

目的 探讨妊娠合并子宫肌瘤的并发症和剖宫产时同时行肌瘤剔除术的指征。方法 对71例妊娠合并子宫肌瘤进行回顾性分析。结果 妊娠合并子宫肌瘤占同期妊娠人数的2．46％，并发症发生率为38．03％。子宫肌瘤使剖宫产率提高。剖宫产术中行肌瘤剔除，未明显增加手术出血量。结论 妊娠合并子宫肌瘤使妊娠并发症发生率明显提高，行剖宫产时应尽量同时剔除肌瘤，以免患者受二次手术的痛苦。     

458例变性及富细胞型子宫平滑肌瘤临床病理分析

目的探讨不同组织学类型变性的子宫平滑肌瘤及富细胞型子宫平滑肌瘤的临床特点。方法回顾性分析北京大学第一医院1993年1月-2004年1月间收治的458例经手术后病理确诊为变性的子宫肌瘤患者的临床特点，并初步评价术前彩色多普勒超声和术中大体标本检查的诊断价值。结果①肌瘤良性变性常见的症状分别是肌瘤生长迅速31．47％(73，232)，腹痛25．86％(60／232)，月经量多或经期长24．57％(57，232)；肌瘤肉瘤变时表现为肌瘤生长迅速66．67％(4，6)；富细胞型平滑肌瘤常表现为月经量多或经期长31．36％(69/220)，腹痛25．91(57／220)，肌瘤生长迅速25％(55/220)。肌瘤生长迅速在肌瘤肉瘤变时尤为明显，与肌瘤良性变性和富细胞型平滑肌瘤比较有显著性区别(P＜0．05)；②肌瘤良性变性者中超声有提示者占25．43％(59/232)，其中RI＜0．4者占17．24％(10/232)；富细胞子宫肌瘤中10．91％(24/220)和子宫肌瘤肉瘤变组33．33％(2／6)术前彩超提示RI＜0．4。③富细胞型子宫肌瘤仅10．91％(24/220)手术时送冰冻切片检查，肌瘤肉瘤变的仅1，6例术中送冰冻检查。结论子宫肌瘤出现变性及富细胞型平滑肌瘤常表现为肌瘤生长迅速，在肌瘤肉瘤变时尤为明显，重视术前的彩色超声多普勒检查及术中仔细的大体标本检查有助于诊断。     

剖宫产术中子宫肌瘤剔除术302例临床分析

子宫肌瘤是生育期妇女最常见的良性肿瘤，文献报道，子宫肌瘤合并妊娠的发病率为0．3％～7．2％，但实际发病率远较上述数字高，如肌瘤不发生变性、疼痛，一般无症状，易被忽视。近年来随着剖宫产率的上升，术中发现子宫肌瘤者日益增多。本文回顾性分析我院302例妊娠合并子宫肌瘤患者剖宫产术中行子宫肌瘤剔除术的资料，探讨其安全性及可行性。     

妊娠合并子宫肌瘤红色变性的处理

子宫肌瘤可以与妊娠同时存在。我科自1984年1月到1992年7月,共收治子宫肌瘤656例,其中合并妊娠者60例,其发生率为9.14％,较文献报道的0.5％～1％为高。但实际上妊娠合并肌瘤的发生率较上述数字高,因为很多孕产妇肌瘤小,又无临床症状,在妊娠和分娩进程中被漏诊。有的小型肌瘤仅在剖宫产时偶然被发现。在656例子宫肌瘤中经临床或术后病理学检查确诊有红色变性者23例,占3.51％,较Faulkner估计肌瘤伴红色变性发生率约7％～8％为低。其中因妊娠合并子宫肌瘤伴红色变性者仅8例,只占肌瘤合并妊娠患者的13.33％,较曹斌融报道40％低。肌瘤红色变性(red degeneration)又称肉样变性     

子宫肌瘤红色变性67例临床分析

目的　研究子宫肌瘤红色变性的临床特征及妊娠期与非妊娠期子宫肌瘤红色变性的异同 ,探讨子宫肌瘤红色变性的发生机制。方法　对 1993～ 2 0 0 2年间手术治疗的 2 3 17例子宫肌瘤患者进行回顾性研究 ,并对行子宫肌瘤切除术的患者进行随访。结果　红色变性 67例 ,占同期 2 3 17例子宫肌瘤患者的 2 89% ,子宫肌瘤合并妊娠患者中 2 1 85%发生红色变性 ,而非妊娠期子宫肌瘤患者仅 1 87%发生红色变性 ,二者差异有统计学意义(P <0 0 0 1)。子宫肌瘤红色变性患者最常见症状为月经改变 ,出现在 2 9 85%的患者 ,2 0 90 %的患者有腹痛症状 ,17 91%的患者肌瘤增大较快 ,16 42 %有肌瘤压痛 ,14 93 %的患者白细胞计数升高。B超提示肌瘤个数妊娠组少于非妊娠组患者 ,最大肌瘤妊娠组 61 54%位于浆膜下 ,而非妊娠组 82 92 %位于肌壁间 ,妊娠组最大肌瘤直径明显小于非妊娠组 ,两组分别为 4 0 8cm和 7 2 8cm ,以上差异均有统计学意义 (P <0 0 0 1)。 97 0 1%的患者最大肌瘤发生变性。行肌瘤切除术的子宫肌瘤红色变性患者术后复发率与是否合并妊娠无明显相关 ,而与肌瘤个数有关 (P =0 0 2 4)。结论　妊娠期与非妊娠期子宫肌瘤患者红色变性发生率、肌瘤大小和部位等临床病理特征存在很大差异 ,考虑其红色变性发生机制     

妊娠合并子宫肌瘤治法探讨

目的 探讨妊娠合并子宫肌瘤的最佳临床治疗方法。方法 对19例妊娠合并子宫肌瘤病例的治疗进行回顾性分析。结果 19例妊娠合并子宫肌瘤患者中，保胎5例，流产2例，剖宫产12例。结论 妊娠合并子宫肌瘤患者，妊娠晚期，剖宫产率高，大部分病例可在剖宫产同时行肌瘤剔除术；妊娠早期，有流产症状者可选用中医药保胎治疗。     

60例妊娠合并子宫肌瘤临床诊治探讨

目的：探讨妊娠合并子宫肌瘤的临床诊治方法及综合防治方法；方法：回顾性分析我院自2007年1月～2009年12月妊娠合并子宫肌瘤孕妇60例的治疗方法及病症情况；结果：2例早孕时影响胚胎生长发育而行流产，剖宫产术36例，占60％。分娩后无产后出血发生，有1例产褥感染及1例子宫复旧不良（P〈0．05）；结论：结合肌瘤大小及位置，采取综合的产前检查与护理及正确的分娩方式是临床治疗妊娠合并子宫肌瘤的可靠方法     

剖宫产术中对常见妇科肿瘤的处理

近年来随着剖宫产率的不断上升 ,术中遇到妇科肿瘤者明显增加。作为产科医师必须对这些妇科肿瘤的处理有充分的了解。妊娠合并妇科肿瘤中最常见的为子宫肌瘤和卵巢肿瘤。1　子宫肌瘤的处理　　妊娠合并子宫肌瘤的发生率约为 0 3 %～ 7 2 % ,肌瘤可位于子宫的各个部位[1] 。1 1　剖宫产时切除肌瘤的可行性　　剖宫产术中对子宫肌瘤的处理 ,目前有两种不同的意见。一种观点认为 :剖宫产术中除带蒂浆膜下肌瘤、靠近剖宫产子宫切口容易剔除的肌瘤或不太大的浆膜下肌瘤外 ,一般多不主张在剖宫产同时行肌瘤剔除术。如有必要切除肌瘤者 ,可待产后…     

妊娠合并子宫肌瘤

妊娠合并子宫肌瘤属高危妊娠，临床上并不罕见，占妊娠的0．03％-1．1％，在肌瘤患者中的发病率为0．5％-1％。妊娠合并子宫肌瘤者并发症发生率高达10％～30％。近年来由于晚婚、高龄分娩者增多以及超声技术在产科领域的广泛应用和诊断技术的提高，其发生率呈上升趋势，我院统计的发病率为2．30％。本文就妊娠与子宫肌瘤之间的相互影响以及妊娠各期肌瘤处理进行综述。     

子宫肌瘤的大小对双胎妊娠产科结局的影响

目的评估子宫肌瘤的大小对双胎妊娠产科结局的影响。方法选取在首都医科大学附属北京妇产医院建档并于2013年6月至2014年12月分娩的双胎妊娠合并子宫肌瘤患者为研究对象,记录肌瘤基本特征、产妇基本人口统计学特征、不良产科并发症及新生儿结局。结果共有51例患者纳入研究,其中34例肌瘤5 cm,17例至少有1个肌瘤≥5 cm。≥5 cm肌瘤者与5 cm肌瘤者相比,其基本人口统计学特征、肌瘤基本特征、不良产科并发症及新生儿结局差异均无统计学意义(P0.05)。≥5 cm肌瘤较5 cm肌瘤的变性率(58.82%vs 11.76%,P=0.001)明显增加。在孕中期,5 cm的肌瘤[(2.87±0.94)vs(3.45±1.22),P=0.018]明显增大。结论子宫肌瘤的大小对双胎妊娠产科结局的影响并不明显。在孕期,≥5 cm的肌瘤更易发生变性。5 cm的肌瘤在孕中期明显增大。     

子宫肌瘤与生育及妊娠安全的相关问题

子宫肌瘤是育龄女性常见良性肿瘤,发病率25%～30%。子宫肌瘤可以引起不孕,以及流产、早产、胎盘早剥、产后出血等不良妊娠结局,增加剖宫产率。子宫肌瘤对生育的影响与其位置以及大小密切相关。其治疗需要个体化,结合肌瘤的大小、位置及患者的生育情况综合考虑。     

晚期妊娠合并生殖道畸形69例临床分析

综合１４年间晚期妊娠合并生殖道畸形的６９例病例，其发生率为０．２８％（６９／２４５１４）。异常生育史１６例，胎膜早破、早产、产后出血、妊高征及剖宫产率均较同期非生殖道畸形者高，差异有显著性（Ｐ＜０．０５）。围产儿病死率为５．８％，显著高于同期围产儿病死率（１．８６％，Ｐ＜０．０１）。新生儿出生体重（ｘ±ｓ）为（３００９±３６２．８５）ｇ，明显低于同期出生儿体重（ｘ±ｓ）（３２８６．６２±４０２．８３）ｇ。有３例新生儿畸形死亡，２例分娩畸形儿死亡史。妊娠前诊断生殖道畸形的母婴并发症明显低于产时、产后诊断者（Ｐ＜０．０５）。生殖道畸形的早期诊断是减少母婴并发症的关键，并总结了早期诊断的要点。强调了对生殖道畸形者进行遗传学检查的重要性。     

Analysis of 65 cases of abruptio placenta]

From Jan 1, 1971 to Dec 12, 1990, 65 cases of abruptio placenta were admitted to our hospital. The incidence was 0.19%. Among them, thirty were complicated by pregnancy induced hypertension (46.2%). The perinatal fetal mortality was 19.7%; perinatal death occurred mostly in the premature group. All babies survived except two abnormalities. Cesarean section rate was 32.3%. All postpartum hemorrhage 29.2%. Couvelaire uterus 6.2%, were cured by conservative treatment. There was neither stillbirth nor newborn death in the thirty three cases treated expectant, but a newborn asphyxia rate of 6.1% and a cesarean section rate of 15.1%. Analysis showed that abruptio placentae should be suspected in cases with abnormal fetal heart rate of unknown cause accompanying signs of labor, premature labor of unknown cause, uterine tongue, ultrasonically visualized liquid from dark area behind the placenta, besides classical signs of abdominal pain and vaginal bleeding. Expectant treatment is appropriate if gestational age is small and no acute symptoms exists so as to minimize the perinatal mortality and cesarean section rate.     

难治性产科出血时子宫切除术和子宫动脉栓塞术的临床分析

目的探讨产科急性出血性疾病治疗过程中进行子宫切除术和动脉栓塞术的临床特点以及选择时机。方法回顾性分析35例产科出血因素行子宫切除或者动脉栓塞病例的临床资料。结果16例子宫切除的患者中,胎盘因素10例,占62.5%（前置胎盘/胎盘植入7例,胎盘早剥伴有凝血功能障碍3例）,子宫异常4例（子宫收缩乏力2例、子宫切口延裂致阔韧带血肿和子宫破裂各1例）占25%;羊水栓塞致DIC后切除子宫2例占12.5%。19例行子宫动脉栓塞术中,前置胎盘3例,占15.8%,子宫收缩异常13例（原发性宫缩乏力产程中剖宫产4例、双胎4例,急产产后出血2例,巨大儿1例,巨大子宫肌瘤2例）占68.4%,剖宫产并发症3例（子宫切口延裂致阔韧带血肿和子宫动脉瘤各1例,剖宫产术后晚期产后出血1例）占15.8%,其中2例栓塞失败,分别行子宫切除术和开腹探查血肿清除术。子宫切除术平均出血量（4 593±2 727）ml,子宫动脉栓塞术时平均出血量（2 601±904）ml,两组比较差异有统计学意义（P〈0.05）。子宫切除组有11例出现了DIC表现占68.7%。行子宫动脉栓塞术时发生DIC1例,占10.5%,差异有统计学意义（P〈0.05）。结论二者均为治疗产后出血的有效手段,但是栓塞术作为保守治疗可以保留生育功能,对于改善患者的预后具有重要的意义,要求尽早采用,一旦发生了严重的DIC和休克,则失去了机会。而保守治疗不能短时间见效,应果断行子宫切除术。     

子宫肌瘤妊娠期变化及对母儿结局影响—372例临床分析

Objective?To investigate the changes of fibroid in pregnancy and the influence on mothers and newborns. Methods?372 pregnant women complicated with fibroid in Peking University People's Hospital from June 2010 to June 2019 were involved, then retrospectively analyzed the clinical data and followed the pregnancy outcome. Results?Compared the size of fibroid in early, late pregnancy and postpartum, the size of fibroid in late pregnancy (2.75±2.35) cm＞early pregnancy (1.79±1.81) cm＞postpartum (1.06±1.35) cm, which had significant difference, (P＜0.05). The cesarean section rate was 50.54% of women with fibroid, which was higher compared with non-fibroid pregnant women (43.01%), with significant difference (P=0.001). There was more postpartum hemorrhage in the cesarean section group and the length of stay which was statistically different from that in the vaginal delivery group (P=0.000). There was no significant difference in postpartum hemorrhage, puerperal disease rate and hospitalization time whether removed fibroids during the cesarean section. Conclusion?The size of fibroids increased during pregnancy, and significantly reduced postpartum. Delivery from vagina could decrease bleeding and had shorter hospital stays, better for the prognosis of the patients with fibroid. Remove the fibroids in the process of cesarean section did not significantly influence the surgery and complications.     

Myoma enucleation during cesarean section: elective procedure or incalculable risk?

Background Myomas are often located in the area of the lower uterine segment. During cesarean section they can lead to problems in delivering the baby and can make it difficult or impossible to close the uterine incision. The goal of the study was to determine the relative risk of a myoma enucleation in combination with a cesarean section.Methods The study included ten pregnant patients in whom a myomatous uterus was expected to present difficulty during birth underwent delivery by cesarean section between 1993 and 2003 at the university departments of gynecology and obstetrics in Frankfurt and Erlangen, Germany. A detailed questionnaire was sent to patients retrospectively.Results Three patients with enucleation of the myoma during cesarean section had a hemoglobin value less than 6.5 g/dl postoperatively. In all three cases the anemia was explained by enucleation of the myoma. The diameter of each myoma was more than 8 cm.Conclusions Depending on the size and location of the myomas, a detailed discussion should be carried out with the patient regarding the associated risks, such as hysterectomy due to hemorrhage and the possible need for blood transfusions.     

40岁以上妇女妊娠结局分析

目的 了解４０岁以上高龄妇女的妊娠及其对分娩的影响。方法 对９３例４０岁以上孕妇（观察组）进行了回顾性与同期分娩的３０岁以下孕妇１８６例（对照组）作对照分析。结果 观察组妊娠合并子宫肌瘤、盆腔子宫内划位症及心脏病发生率（分别为１ ２．９％￣１２．９％及１０．８％）显著高于对照组,其妊娠高综合征、前肋及产后出血发生率（分别为３１．２％、８．６％及１９．４％）显著 对照组。观察组剖（９３．６％）及择期     

Pregnancy complicated by uterine sacculation due to a huge myoma

Uterine sacculation is rare complication affecting the pregnant uterus, and is difficult to diagnose. Sacculation consists of a transitory pouch or sac-like structure caused by inverted uterine polarity. Vaginal delivery is difficult, and even cesarean section can be difficult because of peculiar risks associated with uterine sacculation. We report a pregnant patient with posterior sacculation due to a huge myoma in the lower anterior uterine segment. Sacculation, especially that complicated by a huge myoma, is very difficult to accurately diagnose and makes cesarean section surgery challenging. Because of the myoma in our present case, opening the lower uterine segment was impossible with cesarean section. The uterus was instead opened by corporeal vertical cesarean section. Myomectomy was not performed and the giant myoma thus remained. Postoperative assessment revealed the uterus to still be retroverted. The giant myoma was the cause of sacculation in this case.     

Use of packing in obstetric hemorrhage of uterine origin

OBJECTIVE: To determine the safety and effectiveness of uterine packing to stop hemorrhage in obstetric patients following delivery and pregnancy termination. STUDY DESIGN: A review of obstetric records at Children's Hospital of Buffalo in a 9-year period was undertaken. Patients with uterine packing were identified. Indications, additional medical and surgical procedures, estimated blood loss, postoperative complications and packing material used were reviewed. RESULTS: A total of 9 patients were identified among 34,071. Five patients had hemorrhage during cesarean section. Two patients had hemorrhage after vaginal delivery; 1 case of which had failure with packing and resulted in postpartum hysterectomy. The remaining 2 patients had hemorrhage after dilation and evacuation. Uterine atony unresponsive to oxytocics was the most common indication for uterine packing (44%). The average hematocrit decrease was 10.4% (average total blood loss, 2,200 mL), and all patients received transfusion except 1. The only immediate postoperative complications occurred in a patient with postpartum hysterectomy after failed packing; she developed a pelvic abscess but did well after drainage. CONCLUSION: Uterine packing may be a reasonable alternative to further surgical intervention in patients with intractable obstetric hemorrhage who wish to preserve fertility.     

2002年南京市10家医院剖宫产后出血的病因分析

目的:调查分析与剖宫产后出血的相关因素,为制定合理防治剖宫产后出血措施提供依据。方法:就2002年3月1日至2002年12月31日在南京市10家医院行剖宫产术分娩者有关剖宫产指征、产后出血相关因素进行问卷调查。结果: 1146例剖宫产分娩者产后24h平均出血量528 0ml;出血量≥500ml者447例,占39 .01%,其中宫缩乏力性出血为81 .3%。多因素分析显示,前置胎盘、双胎、新生儿高体重与剖宫产后出血有关。结论:剖宫产后出血发生率高,前置胎盘、双胎和新生儿高体重孕妇是剖宫产后出血的高风险人群。