| Objcetive: To analyze the feasibility of myoemctomy in pregnant women with uterine myoma under cesarean section and to study the significance of the related gene 's expression in uterine fibroids.Methods: 150 cases of full-term single births of pregnant women with uterine fibroids were hospitalized in Obstetrics and gynecology Dpt of the First Affiliated Hospital of Xiamen University from January 2013 to December 2015.The patients were divided into two groups: cesarean section with Uterine myomectomy(observation group,n=80)and no uterine myomectomy(control group,n=70),compared the differences in the situation of childbirth,maternal perinatal and puerperium;followed up 87 patients of150 patients with surgery whom undergo operation more than 1 year or 1 year by January 2016,observation group(n=43): 27 people were reviewed by color Doppler ultrasound;control group(n=45): 30 people were reviewed by color Doppler ultrasound.Check the ER,PR and Ki67 by immunohistochemistry,RT-PCR and Western-blot in myoma of uterus which were removed from pregnant women,analyze the difference between uterine leiomyoma and normal myometrium.Results: 1.The operation time of observation group and control group was 90.12 ±25.46 min VS 82.37 ± 26.72 min;intraoperative blood loss was 325.19±158.17 ml VS298.14 ± 162.78ml;hospital stay was 6.18 ± 1.75 days VS 6.03 ± 1.29 days;the complications were: 6 cases in observation group;4 cases in control group.Perinatal abnormalities were: 20 cases in observation group;18 cases in control group.The difference was not statistically significant(P> 0.05).In observation group,the operation time of the primary and secondary subgroups was 88.12 ± 23.46 min VS 91.72 ± 21.72min;the intraoperative blood loss was 314.22 ± 162.19 ml VS 326.46 ± 158.47ml;the hospitalized time was 5.96 ± 1.45 days VS 6.13 ± 1.69 days;complications were both 3 cases.The difference was not statistically significant(P> 0.05).In the <5cm fibroid and?5cm fibroids subgroups,the operative time was 89.12 ± 22.42 min VS 92.48 ±23.17 min;the intraoperative blood loss was 310.14 ± 168.42 ml VS 320.59 ±170.34ml;the hospitalized time was: 5.97 ± 1.38 days VS 6.24 ± 1.59days;complications were 2 cases and 4 cases respectively.The difference was not statistically significant(P> 0.05).In the intrmurl and subserosal fibroids subgroups,the operation time was 88.46 ± 17.38 min VS 90.48 ± 19.16 min;the intraoperative blood loss was 310.15 ± 163.29 ml VS 306.46 ± 158.45 ml;the hospitalized time was 6.07 ±1.74 days VS 6.08 ± 1.43 days;complications occurred were 2 cases and 4 cases respectively.The difference was not statistically significant(P> 0.05).In the single fibroids and multiple subtypes subgroups,the operation time was 83.12 ± 19.42 min VS95.48 ± 24.17 min(P = 0.01);the intraoperative blood loss was 300.22 ± 148.24 ml VS317.40 ± 160.33ml;the hospital stay was 6.17 ± 1.82 days VS 6.09 ± 1.47 days;the complications were 2 cases and 4 cases respectively.The difference was not statistically significant(P> 0.05).In observation group,66.7% of patients had no recurrence of fibroids.The rate of recurrence of small fibroids(diameter ?5cm)was 25.9%,and no Surgical indications was found.The rate of recurrence of fibroids(diameter >5cm)was7.4%.In control group,46.7% of patients' fibroids sized down,26.7% enlarged,no significant changes were 26.7%.2.ER and PR in gestational uterine fibroids were higher than those in normal myometrium during pregnancy.This was validated by immunohistochemistry,RT-PCR and Western-blot,and the difference between the two groups was statistically significant(P <0.05).The expression of Ki-67 in uterine fibroids during pregnancy was lower than that in normal uterine myometrium during pregnancy.The expression of Ki-67 was validated by immunohistochemistry,RT-PCR and Western-blot,and the difference was statistically significant(P <0.05).Conclusion: 1.There was no significant difference in the time of operation,intraoperative blood loss,hospitalization time and the complication of cesarean section in observation group and control group,and there was no relation with the size or location of fibroids.Uterine myomectomy in pregnant women with uterine myoma under cesarean section is safe and feasible.2.In observation group,the ratio of recurrence of fibroids was 33.3%,but only 7.4% of them needed re-operation.Patients of control group were unable to avoid the possibility of the enlargement of fibroids,although a part of their fibroids had become smaller after delivery.And the fibroids were still exist.Because the time of follow-up was short,we couldn't rule out the possibility of that the fibroids enlarge and need to have operation.So it has value to have uterine myoemctomy in pregnant women with uterine myoma under cesarean section.3.ER,PR and Ki-67 were expressed in uterine fibroids and normal myometrium during pregnancy.ER and PR were highly expressed in uterine fibroids during pregnancy,while Ki-67 were lowly expressed in uterine fibroids during pregnancy.They participate in the gowth of cells of uterine fibroids and normal myometrium,and may be related to the occurrence and development of uterine fibroids during pregnancy. |
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