妊娠合并巨大子宫肌瘤的临床特点及围产结局

目的探讨巨大子宫肌瘤的妊娠期生长情况及其对围产结局的影响。方法 2016年1月至2018年12月,首都医科大学附属北京友谊医院产科共8 268例分娩,其中20例合并巨大子宫肌瘤(巨大肌瘤组),221例子宫肌瘤<9 cm(对照组)。根据分娩前1周的超声检查结果或剖宫产术中所见,肌瘤直径≥9 cm或重量≥800 g定义为巨大子宫肌瘤。患者定期行超声检查明确子宫肌瘤情况,分娩后对新生儿情况进行随访。采用t检验和χ2检验进行统计分析。结果 2016年1月至2018年12月,我院妊娠合并子宫肌瘤的发病率为2.9%(241/8 268),妊娠合并巨大子宫肌瘤的发病率为2.4‰(20/8 268)。巨大肌瘤组与对照组的孕妇年龄、孕产次比较,差异无统计学意义(P>0.05)。巨大肌瘤组20例中,18例患者在我院建档定期产检,早孕期子宫肌瘤平均大小为(9.0±1.9) cm,中孕期平均为(11.5±2.6) cm,晚孕期为(13.1±3.1) cm。巨大肌瘤组与对照组中,肌瘤变性疼痛发生率分别为15.0%(3/20)与6.3%(14/221),差异无统计学意义(P>0.05)。巨大肌瘤组中,1例于妊娠29周因母源性因素引产,1例妊娠32周胎死宫内,余18例分娩孕周为36+6~40周,巨大肌瘤组与对照组新生儿平均出生体重分别为(3 169±716)g与(3 392±452) g,差异无统计学意义(P>0.05)。阴道分娩者中,巨大肌瘤组与对照组的阴道出血量分别为(306±129)ml与(325±168)ml,差异无统计学意义(P>0.05);剖宫产分娩者中,巨大肌瘤组术中出血量大于对照组[分别为(608±269)ml与(166±126)ml,P<0.05)]。结论随着孕周增加,子宫肌瘤可能增大。巨大子宫肌瘤孕妇不增加肌瘤性疼痛综合征的发生率。分娩前应综合评估肌瘤及母儿情况决定分娩方式,产妇有阴道分娩的机会。

Clinical characteristics and perinatal outcomes of pregnant women complicated with giant uterine leiomyoma

Objective To investigate the maternal and fetal outcomes of pregnant women with giant uterine leiomyoma and the growth situation of leiomyoma.Methods From January 2016 to December 2018,there were 8268 pregnant women who deliveried in Beijing Friendship Hospital.Among of them 20 cases with giant fibroids served as giant fibroids group,and 221 cases with leiomyoma less than 9 cm served as control group.According to the ultrasonic results before delivery or the findings during cesarean,the leiomyoma with diameter≥9 cm or weight≥800 g was defined as giant uterine leiomyoma.These patients were examined by ultrasound regularly,and the newborns were followed up after delivery.t test andχ2 test were used for statistical analysis.Results The prevalence of uterine leiomyoma during pregnancy was 2.9%(241/8268)from January 2016 to December 2018.The prevalence of giant leiomyoma was 2.4‰(20/8268).There was no significant difference in the age,the gravidity and parity between the giant leiomyoma group and the control group(P>0.05).18 patients of giant leiomyoma group were registered in our hospital for regular examination.The mean size of leiomyoma in early pregnancy was(9.0±1.9)cm,(11.5±2.6)cm in middle pregnancy,and(13.1±3.1)cm in late pregnancy.The incidence of myomatous pain syndrome in giant leiomyoma group and control group was 15.0%(3/20)vs 6.3%(14/221),with no significant difference.In giant leiomyoma group,one case was terminated for hypertensive disorders complicating pregnancy at 29 weeks,and one case suffered intrauterine fetal death at 32 weeks.Remaining 18 cases were delivered at 36-40+6 weeks of gestation.The average birth weight of the newborn in giant leiomyoma group and control group were(3169±716)g vs(3392±452)g,with no significant difference(P>0.05).There was no significant difference in the volume of vaginal bleeding during vaginal delivery between giant leiomyoma group and control group[(306±129)ml vs(325±168)ml].The amount of bleeding during cesarean section in giant leiomyoma group was(608±269)ml,higher than that in control group[(166±126)ml](P<0.05).Conclusions The volume of uterine leiomyoma is likely to increase during pregnancy.The giant uterine myoma doesn't increase the risk of myomatous pain syndrome.The delivery mode should be assessed by comprehensive situation about leiomyoma,mother and fetus.Patients with giant leiomyoma have the opportunity of natural delivery.