妊娠合并子宫肌瘤剖宫产时处理方法的探讨

目的:探讨妊娠合并子宫肌瘤剖宫产时肌瘤剔除的指征和方法。方法:对164例妊娠合并子宫肌瘤行剖宫产的情况进行分析。结果:肌瘤剔除组、肌瘤未剔除组及对照组(正常剖宫产)术中、术后24h出血量及术前、术后Hb差值无显著性差异。剖宫产术同时行子宫肌瘤剔除术,剔除单发、多发,浆膜下、黏膜下、肌壁间肌瘤,术中出血量无显著性差异。剔除直径≤5cm和直径>5cm的肌瘤,术中出血量有显著性差异(P<0.05)。所有病例术后无一例发生产褥感染,3组的伤口愈合无显著性差异。结论:剖宫产同时应尽量行子宫肌瘤剔除术,但对于直径>5cm,位于子宫下段或远离切口的肌壁间、黏膜下肌瘤,由于手术困难风险较大,不主张剖宫产同时剔除子宫肌瘤。

Cesarean of Pregnancy with Uterus Myoma

Objective: To investigate the better cesarean of pregnancy with uterus myoma. Metheds: The data of 164 cesareans among pregnant patients with uterus myoma were analyzed. Results: Hemorrhage of operation and 24 hours after it and the change of Hb before and after operation had no significant difference between group removing myoma and no removing myoma, between group removing myoma and normal cesarean. Hemorrhage of operation had no significant difference between removing single myoma and multi-myoma, between removing underlying chorion myoma and underlying mucous membrane myoma and myoma among muscle-wall. Hemorrhage of operation had significant difference between myoma (diameter≤5cm) and myoma(diameter>5cm) (P<0.05). There was no puerperal infection among all cases. Incision healing was no significant difference betweens there groups. Conclusion: Removing uterus myoma when performing cesarean should be encouraged in order to avoid another operation. But uterus myoma with diameter more than 5 centimeters or at lower level of uterus or far away from incision are exceptions.