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目的探讨晚期妊娠合并较大子宫肌瘤对母儿的影响。方法选择2007年1月—2010年8月在本院治疗的56例晚期妊娠合并较大子宫肌瘤(直径>8cm)。所有产妇按分娩方式分单纯剖宫产组和剖宫产加子宫肌瘤剔除术组;按肌瘤类型分为浆膜下瘤组、肌壁间肌瘤组、黏膜下肌瘤组;按肌瘤部位分为宫体肌瘤组、子宫下段及宫颈部肌瘤组、阔韧带肌瘤组。比较各组间的术中及术后出血量、手术时间、产褥病率、新生儿体重、窒息等情况。结果单纯剖宫产组和剖宫产加子宫肌瘤剔除组之间差异有统计学意义(P<0.05)。不同肌瘤部位比较显示宫体肌瘤组优于其他二组,且差异有统计学意义(P<0.05)。肌壁肌瘤组优于浆下肌瘤组和黏膜下肌瘤组,差异有统计学意义(P<0.05)。结论对晚期妊娠合并较大子宫肌瘤患者术前应明确肌瘤的部位、类型,在剖宫产时进行积极的剔除,以避免术后的出血等并发症的出现。
Objective To investigate the effect of late pregnant women with large uterine fibroids on mother and child. Methods 56 cases of late pregnancy with large uterine fibroids (diameter> 8cm) treated in our hospital from January 2007 to August 2010 were selected. All mothers according to mode of delivery were cesarean section group and cesarean section plus uterine myomectomy group; according to the type of fibroids were divided into sub-serous tumor group, intramural fibroids group, submucosal fibroids group; The tumor site is divided into uterine fibroids group, lower uterine segment and cervical fibroids group, broad ligament fibroid group. The intraoperative and postoperative blood loss, operation time, puerperal morbidity, neonatal weight, asphyxia and so on were compared among the groups. Results There was a significant difference between simple cesarean section group and cesarean section plus uterine myomectomy group (P <0.05). Different parts of the fibroids showed that the Palace myoma group was better than the other two groups, and the difference was statistically significant (P <0.05). The muscle fibroids group was better than the plasma fibroids group and submucosal fibroids group, the difference was statistically significant (P <0.05). Conclusions Patients with advanced uterine fibroids in the second trimester of pregnancy should have a definite location and type of fibroids before surgery and should be excluded actively during cesarean section to avoid postoperative complications such as bleeding.