剖宫产同时切除子宫肌瘤减少出血的临床研究

目的探讨剖宫产同时行子宫肌瘤切除术减少出血的临床措施及可行性与安全性。方法收集我院2007年3月-2012年11月因妊娠合并子宫肌瘤行子宫下段剖宫产并子宫肌瘤挖除术者276例，其中研究组135例，术前预先经直肠置入米索前列醇600μg，术中剖宫娩出胎儿后采用压挤法切除肌瘤；对照组141例，术中剖宫娩出胎儿后行传统肌瘤切除手术操作。比较两组手术时间、术中出血量、术后24h阴道出血量、恶露持续时间、产后病率、肛门通气时间。结果研究组术中出血量、术后24h阴道出血量均明显少于对照组，组间差异有统计学意义（P〈0．05），而手术时间、肛门通气时间、恶露持续时间及产后病率比较，组间均无统计学差异（P〉0．05）。结论剖宫产同时行子宫肌瘤切除术，采用压挤法联合术前应用米索前列醇可明显减少术中术后出血，安全可行，值得临床推广。

Clinical Study on Reducing Hemorrhage in the Cesarean Section and Simultaneous Hysteromyomecto- my

Objective To discuss the clinical measures on reducing hemorrhage and to explore the feasi- bility and safety in the surgery of cesarean section and simultaneous hysteromyomectomy for pregnant patients with uterine fibroid. Methods The clinical data of 276 pregnant women with uterine fibroid admitted from March 2007 to November 2012 in our hospital were involved in the research retrospectively. All of them were received lower segment cesarean section and simultaneous hysteromyomectomy. 135 cases regarded as research group were administrated misoprostol 600μg rectally in advance, then were performed cesarean section to deliv- ery of fetus, and removal of fibroids by extrusion method. 141 cases as control group were performed cesarean section to delivery of fetus and traditional operative procedures to remove the fibroids simultaneously. The oper- ation time, intraoperative blood loss, total vaginal blood loss during postoperative 24 hours, duration of lochia, puerperal morbidity and gastrointestinal restoration time were compared between two groups. Results Both intraoperative blood loss and total vaginal blood loss during postoperative 24 hours in research group were signif- icantly less than those in control group, there was significant difference between the two groups （P 〈 0.05 ） ; No statistic difference in operative time, duration of lochia, puerperal morbidity and gastrointestinal restoration time between two groups （P 〉 0.05）. Conclusion The measures of extrusion method combined with preoperative misoprostol administration is safe and feasible, and can decrease the perioperative bleeding in cesarean section and simultaneous hysteromyomectomy for pregnant patients with uterine fibroid.