本文選題：子宮肌瘤剔除術　切入點：分娩結局　出處：《浙江大學》2017年碩士論文

【摘要】：目的:探討子宮肌瘤剔除術后患者后續(xù)妊娠的分娩結局。方法:回顧性研究2016年1月1日至2016年12月31日于我院分娩的有子宮肌瘤剔除術史而無其他疤痕子宮病史(包括剖宮產等)的產婦46例,分析其臨床一般資料、圍手術期資料以及后續(xù)妊娠的分娩結局。結果:產婦分娩與肌瘤剔除術間隔時間6-75個月,平均33.73±16.20個月,小于15個月的有5例;除外一例患者雙胎妊娠合并胎膜早破于29+1周行剖宮產術終止妊娠,余45例患者分娩孕周36周-40+5周,平均38.64±1.09周;雙胎妊娠新生兒體重1130/1040g,余45例新生兒體重2280-4440g,平均體重3206.89±403.96g;分娩時18例患者術中探查發(fā)現(xiàn)或產前B超提示子宮肌瘤復發(fā)(復發(fā)率39.13%,18/46),其中12例于剖宮產術中發(fā)現(xiàn)子宮肌瘤并予剔除或電凝;剖官產術中出血200-2200mL,平均 376.32±362mL,超過 500mL 的有 6 例,超過 lOOOmL 的有 2例;8例患者選擇陰道試產,陰道試產率17.39%(8/46),其中27例剖宮產指征均為子宮肌瘤剔除術后疤痕子宮,余為產科因素,8例陰道試產均成功,均為活產,新生兒出生后1分鐘、5分鐘評分均為10分,產婦未見明顯并發(fā)癥。剖宮產術中同時行子宮肌瘤剔除術的患者出血量較單純行剖宮產術的患者多(600±579.97mLvs273.08±104.15mL),有統(tǒng)計學顯著性差異(P = 0.001);陰道分娩組與剖宮產組相比,出血量(212.5vs376.32mL,P = 0.004)、分娩與子宮肌瘤剔除術間隔時間(21.63vs35.55月,P = 0.029)有統(tǒng)計學差異,而年齡、既往陰道分娩史、新生兒體重、分娩孕周、肌瘤剔除術的手術方式、術中是否穿透子宮內膜、分娩時肌瘤是否復發(fā)均無統(tǒng)計學差異。結論:子宮肌瘤剔除術后疤痕子宮的患者可以在嚴格掌握適應證和禁忌證的前提下陰道試產,產程中密切監(jiān)測,若出現(xiàn)產程異常威脅母胎安全時需急診剖宮產術終止妊娠以減少母兒并發(fā)癥。剖宮產術中同時行子宮肌瘤剔除術是可行的,但當肌瘤體積過大、特殊位置或產婦有嚴重合并癥時需謹慎,術中出血量較單純行剖官產術的患者更多。
[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 鹵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 鹵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 鹵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 鹵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 鹵579.97mLvs273.08 鹵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.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.33

【參考文獻】

相關期刊論文 前5條

1 丁翔;張小燕;;剖宮產同時行子宮肌瘤剔除術167例臨床分析[J];中國臨床醫(yī)生雜志;2015年02期

2 張冉;段華;;子宮肌瘤剔除影響術后妊娠的相關因素分析[J];中國現(xiàn)代醫(yī)藥雜志;2014年09期

3 宋光輝;張松英;李百加;韋偉;黃東;林小娜;樓紅英;;腹腔鏡下子宮肌瘤剔除術后妊娠結局及相關因素分析[J];中華醫(yī)學雜志;2013年35期

4 霍翠云;李斌;;不同子宮肌瘤剔除術后復發(fā)及受孕率初步分析[J];中國婦幼保健;2011年04期

5 張慶霞;朱蘭;劉珠鳳;郎景和;孫大為;冷金花;樊慶泊;;開腹與微創(chuàng)子宮肌瘤剔除術臨床結局分析[J];中國實用婦科與產科雜志;2008年04期

，

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