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目的探讨Ⅰ型子宫黏膜下肌瘤电切治疗术前宫颈预处理方法和效果。方法选取2013年6月至2015年6月于上海市普陀区妇婴保健院行电切除治疗的96例Ⅰ型子宫黏膜下肌瘤患者,经随机数字表法分为研究组和对照组,每组48例。对照组于术前阴道放置米索前列醇处理,研究组给予阴道放置卡前列甲酯预处理。所有患者均接受宫腔镜电切治疗,术后定期复诊并接受随访观察。记录两组患者手术及不良反应情况,评价宫颈软化扩张效果,随访观察患者术后恢复情况。结果所有患者均顺利完成手术切除治疗,无大出血、子宫黏膜损伤及子宫穿孔等手术相关并发症发生。研究组手术时间和术中出血量明显低于对照组,差异有统计学意义(P<0.05)。研究组宫颈内口扩张宽度和软化扩张优良率均高于对照组,差异有统计学意义(P<0.05)。术后复查和随访结果显示,两组患者的月经量、血红蛋白、子宫大小恢复情况,以及妊娠成功率比较差异无统计学意义(P>0.05)。结论Ⅰ型子宫肌瘤电切术前应用卡前列甲酯预处理,可有效软化宫颈,利于宫颈口扩张,降低手术操作时间和术中出血量,建议推广应用。
Objective To investigate the method and effect of preoperative cervical pretreatment for type Ⅰ uterine fibroids. Methods 96 patients with type Ⅰ uterine fibroids from June 2013 to June 2015 in Shanghai Putuo District Maternal and Child Health Hospital were randomly divided into study group and control group Group of 48 cases. The control group was treated with misoprostol by vaginal preoperatively, and the study group was given vaginal premedication by card top methyl ester. All patients underwent hysteroscopic electrosurgical treatment, followed up regularly and received follow-up observation. The operation and adverse reactions of the two groups were recorded, the effect of cervix softening and expansion was evaluated, and the postoperative recovery was observed. Results All patients underwent successful surgical resection without any major bleeding, uterine mucosal injury and perforation of the uterus. The operation time and intraoperative blood loss were significantly lower in the study group than in the control group, with significant difference (P <0.05). The study group of cervical intravaginal dilatation width and softening expansion excellent rate were higher than the control group, the difference was statistically significant (P <0.05). Postoperative follow-up and follow-up results showed that there was no significant difference in the menstrual flow, hemoglobin, uterine size recovery, and pregnancy success rate between the two groups (P> 0.05). Conclusion Premature cleavage of type Ⅰ uterine leiomyoma with kanamycin preconditioning can effectively soften the cervix and promote the expansion of the cervix and reduce the operation time and intraoperative blood loss.