子宫肌瘤剔除术后妊娠的分娩结局分析

发布时间：2018-03-29 19:42

本文选题：子宫肌瘤剔除术　切入点：分娩结局　出处：《浙江大学》2017年硕士论文

【摘要】：目的:探讨子宫肌瘤剔除术后患者后续妊娠的分娩结局。方法:回顾性研究2016年1月1日至2016年12月31日于我院分娩的有子宫肌瘤剔除术史而无其他疤痕子宫病史(包括剖宫产等)的产妇46例,分析其临床一般资料、围手术期资料以及后续妊娠的分娩结局。结果:产妇分娩与肌瘤剔除术间隔时间6-75个月,平均33.73±16.20个月,小于15个月的有5例;除外一例患者双胎妊娠合并胎膜早破于29+1周行剖宫产术终止妊娠,余45例患者分娩孕周36周-40+5周,平均38.64±1.09周;双胎妊娠新生儿体重1130/1040g,余45例新生儿体重2280-4440g,平均体重3206.89±403.96g;分娩时18例患者术中探查发现或产前B超提示子宫肌瘤复发(复发率39.13%,18/46),其中12例于剖宫产术中发现子宫肌瘤并予剔除或电凝;剖官产术中出血200-2200mL,平均 376.32±362mL,超过 500mL 的有 6 例,超过 lOOOmL 的有 2例;8例患者选择阴道试产,阴道试产率17.39%(8/46),其中27例剖宫产指征均为子宫肌瘤剔除术后疤痕子宫,余为产科因素,8例阴道试产均成功,均为活产,新生儿出生后1分钟、5分钟评分均为10分,产妇未见明显并发症。剖宫产术中同时行子宫肌瘤剔除术的患者出血量较单纯行剖宫产术的患者多(600±579.97mLvs273.08±104.15mL),有统计学显著性差异(P = 0.001);阴道分娩组与剖宫产组相比,出血量(212.5vs376.32mL,P = 0.004)、分娩与子宫肌瘤剔除术间隔时间(21.63vs35.55月,P = 0.029)有统计学差异,而年龄、既往阴道分娩史、新生儿体重、分娩孕周、肌瘤剔除术的手术方式、术中是否穿透子宫内膜、分娩时肌瘤是否复发均无统计学差异。结论:子宫肌瘤剔除术后疤痕子宫的患者可以在严格掌握适应证和禁忌证的前提下阴道试产,产程中密切监测,若出现产程异常威胁母胎安全时需急诊剖宫产术终止妊娠以减少母儿并发症。剖宫产术中同时行子宫肌瘤剔除术是可行的,但当肌瘤体积过大、特殊位置或产妇有严重合并症时需谨慎,术中出血量较单纯行剖官产术的患者更多。
[Abstract]:Objective: to investigate the outcome of subsequent pregnancy after hysteromyomectomy. Methods: a retrospective study of uterine myomectomy with history of uterine myomectomy without other scar uterine diseases was conducted in our hospital from January 1, 2016 to December 31, 2016. 46 cases of women with history (including cesarean section, etc.), Results: the interval between parturition and myomectomy was 6-75 months (mean 33.73 卤16.20 months). One twin pregnancy with premature rupture of membranes was performed caesarean section for termination of pregnancy in 29 1 weeks, while the other 45 cases had gestational weeks 36 to 405 weeks (mean 38.64 卤1.09 weeks). The weight of the twin pregnancy newborns was 1130 / 1040g, the weight of the remaining 45 neonates was 2280-4440g, the average weight was 3206.89 卤403.96g.The intraoperative exploration of 18 cases during delivery or prenatal B-mode ultrasound suggested the recurrence of uterine leiomyoma (recurrence rate was 39.13% 18 / 46g, 12 of which were found during cesarean section). Tumor is removed or electrocoagulated; The bleeding during operation was 200-2200mL (mean 376.32 卤362mL), 6 cases exceeded 500mL (6 cases), and 2 cases (8 cases) over lOOOmL chose vaginal trial delivery. The rate of vaginal trial delivery was 17.39% (8 / 46). The indication of cesarean section was scar uterus after uterine leiomyoma removal, 27 cases of which were scar uterus after uterine leiomyoma removal. The other 8 cases of vaginal trial labor were all successful, all of them were born alive. The scores of 1 minute and 5 minutes after birth were all 10 points. There was no obvious complication in parturient. The amount of bleeding in the patients who underwent hysteromyomectomy during cesarean section was 600 卤579.97mLvs273.08 卤104.15mL / L, there was significant difference (P = 0.001g) between the vaginal delivery group and the caesarean section group, and there was significant difference between the vaginal delivery group and the cesarean section group (P = 0.001). There were significant differences in blood loss (212.5 vs 376.32mL / L, P = 0.004), the interval between delivery and hysteromyomectomy (21.63 vs 35.55 months, P = 0.029). However, age, history of vaginal delivery, newborn weight, gestational week of delivery, operative method of myomectomy, whether to penetrate the endometrium during the operation, There was no statistical difference in the recurrence of myoma during delivery. Conclusion: patients with scar uterus after uterine myomectomy can be closely monitored in vaginal trial labor under strict indication and contraindication. Emergency caesarean section is needed to terminate pregnancy to reduce the complications of mother and infant if the abnormal birth process threatens the safety of mother and fetus. It is feasible to perform hysteromyomectomy at the same time during cesarean section, but when the size of myoma is too large, Care should be taken when severe complications occur in special location or parturient.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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