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目的：研究妊娠合并子宫肌瘤剖宫产时剔除子宫肌瘤的指征和治疗方法。方法：选择2011 年2 月～2015 年12 月在我院进行诊治的妊娠合并子宫肌瘤患者80 例，根据治疗方法的不同分为观察组40 例与对照组40 例，观察组采用剖宫产时剔除肌瘤治疗，对照组采用单纯剖宫产术，并选择40 例正常剖宫产者为常规组。记录观察组的手术时间、术中出血量、手术前后血红蛋白差值、术后肛门排气时间和住院时间；不同肌瘤大小、类型和数量的术中出血量；比较三组新生儿的一般情况及产妇产后恢复情况。结果：观察组和对照组的肌瘤大小、类型和数量等一般情况相比均无明显差异(P>0.05)；观察组的手术时间明显长于对照组和常规组(P<0.05)，三组间的术中出血量、手术前后血红蛋白差值、术后肛门排气时间和住院时间相比无明显差异(P>0.05)；子宫肌瘤小≤ 5 cm 的患者术中出血量明显小于＞5 cm 的患者(P<0.05)，而不同肌瘤类型和数量的术中出血量无明显差异(P>0.05)；对照组和观察组新生儿评分≤ 7 分、新生儿体重<2500 g、胎儿宫内发育迟缓和早产儿的发生率均明显高于常规组(P<0.05)，对照组和观察组之间相比无明显差异(P>0.05)。结论：妊娠合并子宫肌瘤患者如果肌瘤直径≤ 5 cm可考虑在行子宫肌瘤剔除术；而当直径＞ 5 cm 时，因术中出血量较多且风险较大，剖宫产时不主张同时行肌瘤剔除术。

英文摘要:

Objective:To investigate the indication and treatment of pregnancy complicated with uterine myoma during cesarean section.Methods:Selected 80 cases of patients with uterine myoma who were treated in our hospital from January 2011 to December 2015, divided into two groups according to the treatment, 40 cases in observation group, 40 cases in control group. The observation group was treated with uterine myoma and cesarean section, the control group was treated with simple cesarean section, and 40 cases of normal cesarean section were selected as the routine group. The blood loss, the operation time, intraoperative, before and after the operation of the difference of hemoglobin, postoperative anal exhaust time and hospitalization time; different myoma size, type and number of intraoperative blood loss in the observation group wwere recorded; the neonatal outcome, and maternal postpartum recovery of the three groups were compared.Results:The general condition of the leiomyoma size, type and number in observation group and control group showed no significant difference (P>0.05); the operation time of the observation group was significantly longer than that of the control group and routine group (P<0.05), the amount of bleeding in operation among the three groups, the difference of hemoglobin before and after the operation, the postoperative anal exhaust time and hospitalization time had no significant difference (P>0.05); the bleeding volume of the patients with uterine myoma size ≤ 5 cmwas significantly less than that of above 5 cm(P<0.05), and different tumor types and number of intraoperative bleeding had no significant difference(P>0.05); the incidence of apgar score≤ 7 points, birth weight<2500 g, fetal development retardation and premature of the control group and observation group were significantly higher than those in the conventional group(P<0.05), there was no significant difference between the control group and the observation group (P> 0.05).Conclusion:If the fibroids diameter of pregnancy complicated with uterine myoma is≤ 5 cm, it can be considered to perform myomectomy, when the diameter > 5 cm, the amount of bleeding during operation ismore and the risk isgreater, cesarean section should not be done at the same time.

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