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目的探索妊娠合并子宫肌瘤时行剖宫产术同时行子宫肌瘤剔除术的手术指征,并分析其临床可行性意义及手术的安全性。方法选取我院妇产科从2013年8月~2014年7月期间收治入院的妊娠合并子宫肌瘤行剖宫产术中子宫肌瘤剔除者56例为观察组,同时随机抽取同一时间段行单纯子宫下段剖宫产术无子宫肌瘤合并症的产妇56例为对照组,观察并分析两组产妇手术前后中的四项基本生命体征、相关实验室检查结果、术中出血量、手术时间及术后的临床表现有无差异。结果术中及术后两组产妇的出血发生率分别为观察组12.33%,对照组11.21%,两组差异无统计学意义(P>0 05);两组产妇的催产素使用量、手术前后发热率及血红蛋白值、红细胞压积、术后恶露持续时间、肛门通气及住院时间相比,差异无统计学意义(P>0 05);观察组剖宫术同时行子宫肌瘤剔除术时间比对照组长,两组手术时间对比,差异有统计学意义(P<0.05);子宫肌瘤分为单发和多发、浆膜下和肌壁间,不同部位、大小不同的子宫肌瘤剔除后,术中出血量差异有统计学意义(P<0.05)。所有产妇伤口愈合良好,均无产后并发症发生。结论当子宫肌瘤≤5cm时,行剖宫产手术并子宫肌瘤剔除术,不仅可以减轻患者再次手术的医疗费用及手术的痛苦,而且该手术方案安全可行,并没有因合并子宫肌瘤剔除术而增加手术风险。但当子宫肌瘤位于子宫下段且直径>5cm时,手术风险较大,不推荐临床行剖宫产合并子宫肌瘤剔除术。
Objective To explore the surgical indications of cesarean section with myomectomy in pregnancy with uterine fibroids and to analyze its clinical significance and safety of operation. Methods Obstetrics and Gynecology in our hospital from August 2013 to July 2014 admitted to hospital during pregnancy with uterine fibroids 56 cases of uterine myomectomy in the cesarean section as the observation group, while randomly selected the same period of time line Simple uterine cesarean section without hysteromyoma complications of maternal 56 cases for the control group, observed and analyzed two groups before and after maternal four basic vital signs, the relevant laboratory tests, intraoperative blood loss, operation time And postoperative clinical manifestations are there any differences. Results The incidence of hemorrhage in the two groups was 12.33% in the observation group and 11.21% in the control group, respectively, with no significant difference between the two groups (P> 0.05). The oxytocin consumption, Fever rate and hemoglobin value, hematocrit, duration of postoperative lochia, anus ventilation and hospital stay, the difference was not statistically significant (P> 0.05); the observation group cesarean section at the same time the myomectomy time than Control group leader, the operation time of the two groups were compared, the difference was statistically significant (P <0.05); uterine fibroids are divided into single and multiple, subserosal and muscular wall, different parts, different sizes of myomectomy after culling There was significant difference in the amount of bleeding during operation (P <0.05). All maternal wounds healed well, no postpartum complications occurred. Conclusion When uterine fibroids ≤ 5cm, cesarean section and uterine myomectomy can not only reduce the medical costs and surgical pain of patients undergoing reoperation, but also the surgical scheme is safe and feasible, and there is no culling due to myomectomy Surgery and surgery to increase the risk. However, when the uterine fibroids in the lower uterine segment and diameter> 5cm, the greater the risk of surgery, clinical cesarean section is not recommended combined myomectomy.