妊娠合并子宫肌瘤30例临床分析.docVIP

妊娠合并子宫肌瘤30例临床分析[摘要] 目的:对妊娠合并子宫肌瘤30例患者的诊断和治疗方法进行探讨。方法:回顾性分析30例患者的临床资料。结果:患者阴道分娩8例;行剖宫产术分娩并行子宫肌瘤剔除术21例;1例为肌瘤多发,且直径均5 cm,术中出血较多,且创面较大,为避免感染和出血行全子宫切除;1例为子宫颈肌瘤,因其特殊位置,剖宫产时未行剔除术。结论:子宫肌瘤对生育有较大影响,妊娠合并子宫肌瘤属于高危妊娠应当引起足够的重视并积极治疗,剖宫产行子宫肌瘤剔除术是一种积极可行的方法,临床效果较好。 [关键词] 妊娠合并子宫肌瘤;子宫肌瘤剔除术;剖宫产 [中图分类号] R711.74 [文献标识码]B[文章编号]1673-7210(2010)02(c)-164-02 The diagnosis and treatment about 30 cases of pregnancy with uterine myoma XIAO Caiyan (The People’s Hospital of Wuchuan, Guangdong Province, Wuchuan 524500, China) [Abstract] Objective: To discuss the diagnosisand treatment of the 30 cases of pregnant women with uterine fibroids. Methods: Analyse the clinical data of 30 patients retrospectiveiy. Results: 8 cases of patients were vaginal delivery; cesarean section delivery in parallel with hysteromyomectomy were 21 cases;1 case was multiple fibroids and the diameters were5 cm, with more bleeding and a larger wound during the operation d, so we took total hysterectomy to avoid infection; 1 case of cervical fibroids, which did not be removed in the cesarean section because of its special position. Conclusion: The uterine fibroids have significant impact on fertility, pregnancy with uterine fibroids are high-risk pregnancy which should arouse enough attention and aggressive treatment, cesarean section in parallel with hysteromyomectomy is a positive and practical way to get better clinical effect. [Key words] Pregnancy with uterine fibroids; Myomectomy; Cesarean section 目前研究表明,子宫肌瘤合并妊娠的发病率占肌瘤患者0.5%～1.0%,占妊娠0.3%～0.5%。子宫肌瘤可在产前各时期、分娩期和产褥期带来不良影响,并发症发生率高达10%～40%。现对我院2006年8月～2008年10月所收30例妊娠合并子宫肌瘤患者进行分析如下: 1资料与方法 1.1一般资料 2006年8月～2008年10月我院共收治30例妊娠合并子宫肌瘤患者,年龄22～35岁,平均26.5岁;其中,初产妇14例,经产妇16例;剖宫产术中发现肌瘤患者23例,余7例经B超诊断;其中有流产史患者5例。 1.2肌瘤分类 肌壁间肌瘤20例,浆膜下肌瘤6例,黏膜下肌瘤3例,子宫颈肌瘤1例。 1.3诊断方法 一般肌瘤根据病史、妇科检查可诊断。B型超声可以较明确显示肌瘤大小及部位;是诊断子宫肌瘤主要手段之一;同时腹腔镜检查、子宫输卵管造影可协助诊断。较小的肌瘤,常因肌瘤小、无临床症状等特点在妊娠分娩过程中被忽略[1-2],仅在剖宫产时发现。 1.4手术方法 先行子宫下段剖宫产娩出胎儿和胎盘,若宫腔内发现黏膜下肌瘤的,则于蒂部剪除并缝扎残端,若无黏膜下肌瘤先将子宫切