發(fā)布時間：2018-04-26 06:35

  本文選題：子宮肌瘤 + 子宮肌瘤剔除術(shù)��； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：目的:子宮肌瘤是婦科最常見的盆腔良性腫瘤,可能影響育齡婦女的妊娠率。子宮肌瘤剔除術(shù)是保留生育功能最常用的治療方法。但子宮肌瘤剔除術(shù)后妊娠存在子宮破裂的風(fēng)險,是威脅母兒生命安全最嚴(yán)重的產(chǎn)科并發(fā)癥之一。近年來其報道逐漸增多,但其危險因素及預(yù)防措施尚未達(dá)成共識。本文報道我院子宮肌瘤剔除術(shù)后子宮破裂病例三例,并結(jié)合相關(guān)文獻報道,旨在總結(jié)分析子宮肌瘤剔除術(shù)后子宮破裂的臨床診治及導(dǎo)致子宮破裂可能的危險因素,從而降低子宮破裂發(fā)生風(fēng)險。方法:回顧性分析我院聯(lián)眾病案系統(tǒng)內(nèi)記錄的3例子宮肌瘤剔除術(shù)后子宮破裂患者的臨床資料,了解其臨床特點,結(jié)合復(fù)習(xí)相關(guān)文獻,探討術(shù)后子宮破裂與手術(shù)方式、熱損傷、縫合、子宮肌瘤特點、術(shù)后避孕時間及終止妊娠方式的相關(guān)性。結(jié)果:本文報道的3例子宮肌瘤剔除術(shù)后子宮破裂患者均為育齡期女性。其中1例患者子宮肌瘤直徑約5cm,位于子宮宮底偏右宮角處,行腹腔鏡下子宮肌瘤剔除術(shù),術(shù)中多次使用電凝,未穿透子宮粘膜層,予1/0可吸收腸線雙層等間距縫合子宮肌層,術(shù)后避孕9月余,于妊娠34+周時發(fā)生完全性子宮破裂,癥狀較典型,立即行剖宮產(chǎn)術(shù)及子宮破裂口修補術(shù),術(shù)后母嬰恢復(fù)良好。另1例患者子宮肌瘤直徑約9cm,位于子宮后壁肌壁間,行經(jīng)腹子宮肌瘤剔除術(shù),術(shù)中未使用電凝,子宮內(nèi)膜完整,予2/0合成的可吸收線雙層間斷縫合子宮肌層,術(shù)后避孕5月余,于妊娠38周計劃性剖宮產(chǎn)術(shù)終止妊娠術(shù)中發(fā)現(xiàn)不完全性子宮破裂,術(shù)前無明顯癥狀,術(shù)中行子宮破裂口修補術(shù),術(shù)后母嬰恢復(fù)良好。還有1例患者為子宮多發(fā)肌瘤,行經(jīng)腹子宮肌瘤剔除術(shù),術(shù)中共剔除19枚直徑0.5～8cm不等的子宮肌瘤,分別位于宮底、前壁、右側(cè)壁及后壁,術(shù)中未使用電凝,子宮內(nèi)膜完整,予1-0腸線"8"字縫合止血并關(guān)閉瘤腔,再連續(xù)縫合子宮漿膜層,術(shù)后避孕21月,于妊娠36+周計劃性剖宮產(chǎn)術(shù)終止妊娠術(shù)中發(fā)現(xiàn)不完全性子宮破裂,術(shù)前無明顯癥狀,術(shù)中行子宮破裂口修補術(shù),術(shù)后母嬰恢復(fù)良好。結(jié)論:子宮肌瘤剔除術(shù)后自發(fā)子宮破裂罕見,一旦發(fā)生,對母嬰來說都可能是致命的。因此手術(shù)者應(yīng)嚴(yán)格把握手術(shù)指征,術(shù)中應(yīng)減少電熱器械的過度使用,盡量避免進入宮腔破壞子宮內(nèi)膜完整性,仔細(xì)縫合子宮肌層,術(shù)后合理的避孕時間及個體化選擇終止妊娠方式與時間,以降低術(shù)后妊娠子宮破裂風(fēng)險。
[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.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.33;R714.2

【相似文獻】

相關(guān)期刊論文 前10條

1 呂秋波,王少為,張毅,趙曉東;陰式子宮肌瘤剔除術(shù)的臨床研究[J];中國實用婦科與產(chǎn)科雜志;2005年01期

2 張敏華;黃小芬;陳建蓮;;陰式子宮肌瘤剔除術(shù)42例臨床分析[J];中國基層醫(yī)藥;2006年01期

3 吳東寧;秦岳;;陰式子宮肌瘤剔除術(shù)23例臨床分析[J];青海醫(yī)藥雜志;2006年04期

4 景頌恩;董長江;;陰式子宮肌瘤剔除術(shù)95例臨床分析[J];鄭州大學(xué)學(xué)報(醫(yī)學(xué)版);2006年05期

5 李娟;;不同方式子宮肌瘤剔除術(shù)臨床分析[J];四川醫(yī)學(xué);2007年06期

6 周賢瓊;;陰式子宮肌瘤剔除術(shù)46例臨床分析[J];中國醫(yī)療前沿;2007年18期

7 韋靜;貢麗霞;;腹腔鏡與經(jīng)腹部子宮肌瘤剔除術(shù)臨床療效比較[J];中國實用醫(yī)藥;2007年36期

8 戴夏琳;陳向東;;陰式子宮肌瘤剔除術(shù)的臨床療效分析[J];廣西中醫(yī)學(xué)院學(xué)報;2008年04期

9 劉玫，

本文編號：1804926