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目的探讨剖宫产术中同时行子宫肌瘤剔除术的安全性和可行性。方法妊娠合并子宫肌瘤行剖宫产术产妇165例;其中,术中同时行子宫肌瘤剔除术者117例(A组),单纯剖宫产术未处理肌瘤者48例(B组)。另外选择行剖宫产无子宫肌瘤的单胎产妇80例作为对照(C组)。比较三组手术时间、术中出血量、术后2-h出血量、产褥病率和住院时间等指标。结果 A组手术时间(54.3±11.9)min,长于B、C组的(39.1±11.7)min、(36.4±10.5)min(P<0.05);A组术中出血量大于C组[(297.8±55.1)ml vs.(258.4±63.8)ml](P<0.05)。三组术后2-h出血量和产褥病率及住院时间差异无统计学意义(P>0.05)。肌瘤直径≥5cm者手术时间及术中出血量大于肌瘤直径<5cm者(P<0.05)。未行肌瘤剔除的主要原因为宫缩乏力、近宫角大血管、后壁近宫颈和多发性米粒样大小肌瘤。结论多数病例在剖宫产术中同时行子宫肌瘤剔除术是可行的,但术中应积极处理出血。
Objective To investigate the safety and feasibility of myomectomy in cesarean section. Methods One hundred and sixty-five women with cesarean section during pregnancy were enrolled in this study. Among them, 117 cases were treated with myomectomy at the same time (group A), 48 cases without fibroids by cesarean section (group B) . Another choice of cesarean section without uterine fibroids single fetus 80 cases as a control (C group). The operation time, intraoperative blood loss, postoperative 2-h blood loss, puerperal morbidity and hospital stay were compared. Results The operative time of group A was (54.3 ± 11.9) min, longer than that of group B and C (39.1 ± 11.7) min and (36.4 ± 10.5) min respectively (P <0.05) 55.1) ml vs. (258.4 ± 63.8) ml] (P <0.05). No significant difference was found in the amount of bleeding 2-h and the rate of puerperal and hospital stay in the three groups (P> 0.05). Fibroids ≥ 5cm diameter surgery time and intraoperative blood loss greater than fibroids <5cm (P <0.05). The main reason for not myomectomy is uterine atony, near the Palace of the great vessels, posterior wall of the cervix and multiple myeloma. Conclusions Most cases of myomectomy at the same time in cesarean section is feasible, but bleeding should be actively treated during operation.