剖宫产分娩中不同类型子宫肌瘤剔除术的临床特征分析

doi:10.3969/j.issn.1006-7795.2022.04.022

首都医科大学学报 ›› 2022, Vol. 43 ›› Issue (4): 653-657.doi: 10.3969/j.issn.1006-7795.2022.04.022

剖宫产分娩中不同类型子宫肌瘤剔除术的临床特征分析

路畅¹, 胡江涛¹, 李金皎², 姜海利^2*

1.首都医科大学附属北京妇产医院/北京妇幼保健院妇科,北京 100026;
2.首都医科大学附属北京妇产医院/北京妇幼保健院产科,北京 100026

收稿日期:2022-03-01 出版日期:2022-08-21 发布日期:2022-10-28

Clinical analysis of cesarean delivery with cesarean myomectomy in pregnant women with different types of uterine myomas

Lu Chang¹, Hu Jiangtao¹, Li Jinjiao², Jiang Haili^2*

1. Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100026, China;
2. Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100026, China

Received:2022-03-01 Online:2022-08-21 Published:2022-10-28
Contact: *E-mail:jianghaili2020@ccmu.edu.cn

摘要/Abstract

摘要： 目的探讨不同类型的妊娠合并子宫肌瘤孕妇剖宫产术同时行子宫肌瘤剔除的临床结局。方法回顾性分析剖宫产分娩同时行子宫肌瘤剔除的孕妇246例,根据子宫肌瘤类型不同分为浆膜下子宫肌瘤组(135例)和肌壁间子宫肌瘤组(111例),分析其临床特征和结局。结果 ①肌壁间子宫肌瘤组中,孕妇年龄、子宫肌瘤≥ 5 cm的比例和多发子宫肌瘤的比例均明显高于浆膜下子宫肌瘤组(37岁 vs 34岁, χ²=-3.640, P=0.000;50.5% vs 25.9%, χ²=15.719, P=0.000; 55.0% vs 23.0%, χ²=26.630, P=0.000)。②肌壁间子宫肌瘤组的手术时间以及常规应用缩宫素20 U的基础上额外应用缩宫素的比例明显高于浆膜下子宫肌瘤组(50 min vs 45 min, Z=-3.349, P=0.001; 49.5% vs 29.6%, χ²=10.197, P=0.001),产后出血≥ 500 mL的比例和出血量也明显增加(47.7% vs 33.3%, χ²=5.281, P=0.022; 530 mL vs 400 mL, Z=-3.247, P=0.001)。结论剖宫产术中行肌壁间子宫肌瘤剔除额外应用缩宫素的比例和出血量均明显增加,但不增加严重产后出血风险。

关键词: 不同类型妊娠合并子宫肌瘤, 剖宫产术中子宫肌瘤剔除, 手术特征, 分娩结局

Abstract: Objective To explore the clinical outcomes of cesarean myomectomy (CM) in pregnant women with different types of uterine myomas. Methods A retrospective cohort study of 246 singleton pregnancies with different types of uterine myomas underwent cesarean section and CM was performed. There were subserosal myomas (SM) group (135 cases) and intramural myomas (IM) group (111 cases) according to the different types of uterine myomas. The clinical characteristics and delivery outcomes were analyzed. Results ① In IM group, the maternal age,the proportion of myomas(≥5 cm)and the proportion of multiple myomas were significantly higher than those in SM group (37 years vs 34 years, χ²=-3.640, P=0.000; 50.5% vs 25.9%, χ²=15.719, P=0.000; 55.0% vs 23.0%, χ²=26.630, P=0.000). ② In IM group, the operation time and the proportion of using additional oxytocin were higher than those in SM group significantly (50 min vs 45 min, Z=-3.349, P=0.001; 49.5% vs 29.6%, χ²=10.197, P=0.001). In IM group, blood loss ≥500 mL and the blood loss increased significantly than that in SM group (47.7% vs 33.3%, χ²=5.281, P=0.022; 530 mL vs 400 mL, Z=-3.247, P=0.001). Conclusion The proportion of using additional oxytocin and blood loss increased in CM in singleton pregnant women with intramural myomas,but the risk of severe postpartum hemorrhage (PPH) did not increase.

Key words: different types of uterine myomas, cesarean myomectomy (CM), operation features, delivery outcomes

中图分类号:

R713.4

路畅, 胡江涛, 李金皎, 姜海利. 剖宫产分娩中不同类型子宫肌瘤剔除术的临床特征分析[J]. 首都医科大学学报, 2022, 43(4): 653-657.

Lu Chang, Hu Jiangtao, Li Jinjiao, Jiang Haili. Clinical analysis of cesarean delivery with cesarean myomectomy in pregnant women with different types of uterine myomas[J]. Journal of Capital Medical University, 2022, 43(4): 653-657.

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剖宫产分娩中不同类型子宫肌瘤剔除术的临床特征分析

Clinical analysis of cesarean delivery with cesarean myomectomy in pregnant women with different types of uterine myomas

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