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目的探讨早孕合并子宫肌瘤切除术史患者的终止妊娠方式及子宫肌瘤切除对人工流产术(人流)并发症的影响。方法回顾性分析52例宫内妊娠6~10周合并子宫肌瘤、子宫腺肌瘤切除史患者的临床资料,同时选取60例无子宫肌瘤切除史早孕妇女为对照组,其中超声引导下人工流产30例、药物流产(药流)30例。结果 52例患者中宫腔镜下黏膜下肌瘤切除术10例,腹腔镜下29例,开腹13例;合并子宫腺肌7例;单发子宫肌瘤或腺肌瘤34例,多发子宫肌瘤18例;术前肌瘤最大直径1.5~11 cm,直径≥5 cm 40例,<5 cm 12例;肌瘤切除距离妊娠时间8个月~15年;9例胎囊距离子宫浆膜层小于1 cm,均经MRI检查排除胎囊子宫肌层种植。23例采用超声引导下负压电吸人工流产术,均为一次成功,23例B超监视下,与其人流对照组比较,手术时间明显延长(P<0.05),但术中出血量及术后残留率比较,差异无统计学意义(P>0.05)。29例(包括胎囊距离子宫浆膜层小于1 cm 9例)药物流产术,残留率为27.59%,明显高于其药流对照组(P<0.05)。结论对于早孕合并子宫肌瘤切除术史患者,超声引导下人流术定位准确、损伤性小,明显减少了术后残留,手术安全性高;对于可能存在子宫切口愈合欠佳者,药物流产可减少严重并发症的发生。
Objective To investigate the effect of termination of pregnancy and the myomectomy on the complications of artificial abortion (abortion) in patients with early pregnancy and myomectomy. Methods Retrospective analysis of 52 cases of intrauterine pregnancy 6 to 10 weeks with uterine fibroids, adenomyosis history of patients with clinical data at the same time select 60 cases without myomectomy history of early pregnancy women as control group, including ultrasound guided artificial 30 cases of abortion, medical abortion (abortion) 30 cases. Results In 52 cases, 10 cases underwent hysteroscopic submucous myoma resection, 29 cases under laparoscopy, 13 cases open laparotomy, 7 cases combined adenomyosis, 34 cases single uterine leiomyoma or adenomyoma, multiple uterine Fibroids in 18 cases; preoperative fibroids maximum diameter of 1.5 ~ 11 cm, diameter ≥ 5 cm 40 cases, <5 cm 12 cases; myomectomy from pregnancy time of 8 months to 15 years; 9 cases of fetal distance from the uterine serosa Layer is less than 1 cm, were examined by MRI exclusion fetal myometrial plantation. Twenty-three patients underwent induced abortion under the guidance of ultrasound, both of which were successful. The operation time was significantly longer in 23 patients with B-ultrasound surveillance than that in control group (P <0.05), but the intraoperative blood loss and postoperative Residual rate comparison, the difference was not statistically significant (P> 0.05). In 29 cases (including 9 cases of fetal capsule less than 1 cm from the uterine serosal layer), the residual rate was 27.59%, which was significantly higher than that of the control group (P <0.05). Conclusion For patients with early pregnancy and myomectomy history, abortion guided by ultrasound is accurate and less invasive, significantly reducing the postoperative residual and high surgical safety. For patients who may have uterine incision healing, medical abortion may be reduced Serious complications occur.