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目的:探讨开腹子宫肌瘤剔除术中出血的相关因素,并评估术中止血带应用的临床价值。方法:回顾分析2010年1月至2012年11月于北京协和医院妇产科行开腹子宫肌瘤剔除术的患者112例。以术后血红蛋白(Hb)下降值作为评估术中出血的主要指标,分析术中出血的相关影响因素。并比较分析术中应用止血带对患者术中输血率、手术时间、术后Hb及红细胞压积下降值、术后病率、输血率、术后住院天数及住院费用的影响。结果:(1)子宫大小、肌瘤数量以及直径≥5cm肌瘤的数量与术后Hb下降值呈直线正相关(P均<0.05);(2)术中进宫腔者术后Hb下降值显著高于术中未进宫腔者[(24.90±17.15)g/dl vs(17.73±10.04)g/dl,P=0.006];(3)止血带组与对照组的术前评估及术中输血率、手术时间、术后病率、术后住院天数、住院费用无显著差异,但止血带组的术后Hb下降值显著低于对照组[(16.36±11.37)g/dl vs(21.53±13.62)g/dl,P=0.046]。结论:影响开腹子宫肌瘤剔除术术中出血的主要因素为子宫大小、肌瘤数量、直径≥5cm肌瘤的数量,术中是否进宫腔及术中是否应用止血带等。术中应用止血带可减少术后Hb的下降,且并不增加术后病率、住院时间及住院费用。
Objective: To investigate the related factors of hemorrhage in open myomectomy and evaluate the clinical value of intraoperative tourniquet. Methods: A retrospective analysis of January 2010 to November 2012 in Beijing Union Medical College Hospital gynecologic obstruction of myomectomy 112 patients. Postoperative hemoglobin (Hb) decreased as the main indicator of intraoperative bleeding, the analysis of intraoperative bleeding related factors. The effects of tourniquet on intraoperative blood transfusion rate, operation time, postoperative Hb and hematocrit decline, postoperative morbidity, transfusion rate, postoperative hospital stay and hospitalization costs were compared and analyzed. Results: (1) There was a linear positive correlation between the number of uterine fibroids, the number of fibroids and the diameter of fibroids ≥5cm (all P <0.05); (2) The postoperative Hb decrease (24.90 ± 17.15) g / dl vs (17.73 ± 10.04) g / dl, respectively, P = 0.006]; (3) The preoperative evaluation of the tourniquet group and the control group and the intraoperative There was no significant difference in blood transfusion rate, operation time, postoperative morbidity, postoperative hospital stay and hospitalization costs, but the postoperative Hb decrease in tourniquet group was significantly lower than that in control group [(16.36 ± 11.37) g / dl vs (21.53 ± 13.62) g / dl, P = 0.046]. Conclusion: The main factors that influence the bleeding during myomectomy are the size of the uterus, the number of fibroids, the number of fibroids with diameter ≥5cm, whether intraoperatively enter the uterine cavity and whether to apply the tourniquet. Intraoperative tourniquet can reduce postoperative Hb decline, and does not increase the postoperative morbidity, length of stay and hospitalization costs.