Clinical Analysis Of Hysteromyomectomy During Cesarean Section

Objective:.To study retrospectively the cases of hysteromyomectomy during cesarean section and conduct clinical analysis to discuss the safety and feasibility of this operation.Method:A total of 338 pregnant patients with uterine fibroids and cesarean section who were delivered in the Department of obstetrics,Peony People’s Hospital of Heze City from January 2010 to December 2018 were selected and divided into two groups according to whether or not fibroids were removed during the operation: the myomectomy group(n=188)and the myomectomy group(n=150).A total of 180 patients with elective cesarean section without uterine fibroids were randomly selected as the control group.Retrospective analysis of the data was conducted to compare the effects of the three groups on intraoperative and postoperative complications and perinatal outcomes.The myomectomy group was divided into different groups according to the diameter,location,number and type of fibroids,and the influence of each group on intraoperative and postoperative complications was compared.At the same time,the incidence of second pregnancy in the studied cases was compared and analyzed.Result:1.Compared with the control group and the fibroid-removed group,the operative time of the fibroid-removed group was significantly longer than that of the control group and the fibroid-removed group,the difference was statistically significant(P<0.05),while there was no statistically significant difference between the fibroid-removed group and the control group(P>0.05).In the three groups,the amount of oxytocin in the myomectomy group was higher than that in the non-myomectomy group and the control group,and the difference was statistically significant(P<0.05).There was no statistically significant difference between the non-myomectomy group and the control group(P>0.05).2.There was no significant difference in the amount of intraoperative blood loss and the decrease of hemoglobin 24 hours after operation between the myomectomy group and the unmyomectomy group and the control group(P>0.05).There were no significant differences in blood transfusion,fever,postoperative exhaust time and postoperative hospital stay among the three groups(P>0.05).3.There was no statistical significance in the perinatal outcome(neonatal asphyxia,neonatal malformation and low birth weight)between the three groups(P>0.05).4.Comparison of surgical conditions of different sizes of fibroids in the myomectomy group(≥5cm group,<5cm group):Compared with the fibroids <5cm group,there were statistically significant differences in the length of operation,the amount of intraoperative blood loss and the decrease of hemoglobin 24 hours after operation(P<0.05).There was no significant difference in the length of postoperative hospital stay between the two groups(P>0.05).5.Comparison of operation conditions of different sites of fibroids in the myomectomy group(fundus,uterine body,cervix and uterine horn):The operative time for removing the cervical and uterine cornus fibroids was significantly higher than that of the fundus and uterine body(P<0.05),but there was no statistical significance between the fundus and uterine body group(P>0.05).There was no statistical significance in intraoperative blood loss,postoperative hemoglobin reduction 24 hours after operation and postoperative hospital stay among the three groups(P > 0.05).6.Comparison of different number of fibroids in the myomectomy group(single fibroid group,multiple fibroids group):There were no significant differences between the two groups in operative time,intraoperative blood loss,decreased hemoglobin 24 hours after operation,and postoperative hospital stay(P>0.05).7.Comparison of operative conditions of different types of fibroids in the myomectomy group(subserosal,intramural and submucosal):There was no statistical significance in operation time,intraoperative blood loss,decreased hemoglobin 24 hours after operation,and postoperative hospitalization days among the fibroids groups(P>0.05).8.Statistical results of postoperative pathology showed that all the patients were uterine leiomyoma,including 146 undegenerated cases and 42 degenerated cases.Most of them were red degeneration(31cases,16.5%),hyalinosis(9cases,4.8%)and cystic degeneration(2cases,1.0%).9.Statistical analysis of the changes of fibroids in patients with unremoved fibroids 6weeks to 3 months after surgery: 98 cases had reduced fibroids,52 cases had no significant changes,and no enlarged fibroids.10.Statistical analysis of the renecropsy and delivery of the three groups of patients:In the myomectomy group,101 patients had cesarean section again,32patients(31.7%)had pelvic and abdominal adhesion,10 patients(9.9%)had placenta implantation(9 patients with adhesion type and 1 patient with implantation type),and 1 patient(1.0%)had incomplete uterine rupture.In the unremoved myoma group,87 patients delivered by cesarean section again,23patients(26.4%)had pelvic and abdominal adhesion,and7patients(8.0%)had placenta implantation(all were adhesion type),without uterine rupture.In the control group,98 patients had cesarean section again,28patients(28.6%)had pelvic and abdominal adhesion,7patients(7.1%)had placenta implantation(all adhesion type),and 1patient(1.0%)had incomplete uterine rupture.There was no case of complete uterine rupture in the three groups.There were no significant differences in the incidence of pelvic and abdominal adhesion,placenta implantation and uterine rupture during the second pregnancy among the three groups(P>0.05).Conclusion:1.Although myomectomy in cesarean section prolonged the operation time and increased the amount of oxytocin,it did not cause serious effects during and after the operation.2.Myomectomy combined with cesarean section did not increase the risk of long-term complications.3.It is safe and feasible to perform myomectomy during cesarean section.