子宫肌瘤剔除术后妊娠子宫破裂三例并文献回顾

发布时间：2018-04-26 06:35

本文选题：子宫肌瘤 + 子宫肌瘤剔除术　；参考：《浙江大学》2017年硕士论文

【摘要】：目的:子宫肌瘤是妇科最常见的盆腔良性肿瘤,可能影响育龄妇女的妊娠率。子宫肌瘤剔除术是保留生育功能最常用的治疗方法。但子宫肌瘤剔除术后妊娠存在子宫破裂的风险,是威胁母儿生命安全最严重的产科并发症之一。近年来其报道逐渐增多,但其危险因素及预防措施尚未达成共识。本文报道我院子宫肌瘤剔除术后子宫破裂病例三例,并结合相关文献报道,旨在总结分析子宫肌瘤剔除术后子宫破裂的临床诊治及导致子宫破裂可能的危险因素,从而降低子宫破裂发生风险。方法:回顾性分析我院联众病案系统内记录的3例子宫肌瘤剔除术后子宫破裂患者的临床资料,了解其临床特点,结合复习相关文献,探讨术后子宫破裂与手术方式、热损伤、缝合、子宫肌瘤特点、术后避孕时间及终止妊娠方式的相关性。结果:本文报道的3例子宫肌瘤剔除术后子宫破裂患者均为育龄期女性。其中1例患者子宫肌瘤直径约5cm,位于子宫宫底偏右宫角处,行腹腔镜下子宫肌瘤剔除术,术中多次使用电凝,未穿透子宫粘膜层,予1/0可吸收肠线双层等间距缝合子宫肌层,术后避孕9月余,于妊娠34+周时发生完全性子宫破裂,症状较典型,立即行剖宫产术及子宫破裂口修补术,术后母婴恢复良好。另1例患者子宫肌瘤直径约9cm,位于子宫后壁肌壁间,行经腹子宫肌瘤剔除术,术中未使用电凝,子宫内膜完整,予2/0合成的可吸收线双层间断缝合子宫肌层,术后避孕5月余,于妊娠38周计划性剖宫产术终止妊娠术中发现不完全性子宫破裂,术前无明显症状,术中行子宫破裂口修补术,术后母婴恢复良好。还有1例患者为子宫多发肌瘤,行经腹子宫肌瘤剔除术,术中共剔除19枚直径0.5～8cm不等的子宫肌瘤,分别位于宫底、前壁、右侧壁及后壁,术中未使用电凝,子宫内膜完整,予1-0肠线"8"字缝合止血并关闭瘤腔,再连续缝合子宫浆膜层,术后避孕21月,于妊娠36+周计划性剖宫产术终止妊娠术中发现不完全性子宫破裂,术前无明显症状,术中行子宫破裂口修补术,术后母婴恢复良好。结论:子宫肌瘤剔除术后自发子宫破裂罕见,一旦发生,对母婴来说都可能是致命的。因此手术者应严格把握手术指征,术中应减少电热器械的过度使用,尽量避免进入宫腔破坏子宫内膜完整性,仔细缝合子宫肌层,术后合理的避孕时间及个体化选择终止妊娠方式与时间,以降低术后妊娠子宫破裂风险。
[Abstract]:Objective: uterine leiomyoma is the most common pelvic benign tumor in gynecology, which may affect the pregnancy rate of women of childbearing age. Uterine leiomyomectomy is the most commonly used treatment to preserve fertility function. However, pregnancy after uterine leiomyomectomy has the risk of uterine rupture, which is one of the most serious obstetric complications threatening the life of mother and infant. In recent years, its reports have been increasing, but its risk factors and preventive measures have not reached consensus. This paper reports three cases of uterine rupture after hysteromyomectomy in our hospital. The purpose of this paper is to summarize and analyze the clinical diagnosis and treatment of uterine rupture after hysteromyomectomy and the possible risk factors of uterine rupture. Thus reducing the risk of uterine rupture. Methods: the clinical data of 3 patients with uterine rupture after hysteromyomectomy were analyzed retrospectively. Suture, hysteromyoma characteristics, postoperative contraceptive duration and termination of pregnancy. Results: the 3 cases of uterine rupture after hysteromyomectomy were all women of childbearing age. In one case, the diameter of uterine myoma was about 5 cm, which was located at the right corner of the uterine fundus. The uterine myomectomy was performed under laparoscope. The uterine myoma was electrocoagulated many times during the operation. The uterine myoma was sutured with 1 / 0 absorbable intestinal line at double spaced and equal-spaced suture. Complete rupture of uterus occurred at 34 weeks of gestation, and the symptoms were typical. Caesarean section and repair of uterine rupture were performed immediately, and the recovery of mother and child was good. Another patient had a uterine myoma about 9 cm in diameter, located between the wall of the posterior wall of the uterus, underwent transabdominal hysteromyomectomy without electrocoagulation, complete endometrium, and was sutured with 2 / 0 absorbable double layer suture of the myometrium, and more than 5 months after the operation. Incomplete rupture of uterus was found in the termination of pregnancy by planned cesarean section at 38 weeks of gestation without obvious symptoms before operation. Another patient, multiple myoma of uterus, underwent transabdominal hysteromyomectomy. Nineteen uterine leiomyomas with different diameters of 0.5~8cm were removed, which were located in the fundus, anterior wall, right wall and posterior wall of uterus, respectively, without electrocoagulation and intact endometrium. 1-0 intestinal line "8" was given to stop bleeding and close the tumour cavity, then the uterine serosa was sutured continuously. After 21 months of contraception, incomplete rupture of the uterus was found during the termination of pregnancy by planned cesarean section at 36 weeks of gestation, without obvious symptoms before operation. Intraoperative repair of uterine rupture was performed, and the recovery of mother and child was good. Conclusion: spontaneous uterine rupture after hysteromyomectomy is rare. Once it occurs, it can be fatal to mother and child. Therefore, the operator should strictly grasp the indications of the operation, reduce the excessive use of electrothermal instruments during the operation, avoid entering the uterine cavity to destroy the integrity of the endometrium, and carefully suture the myometrium of the uterus. The reasonable contraceptive time and individual choice of termination of pregnancy were used to reduce the risk of uterine rupture.
【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;R714.2

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