Department of Obstetrics and Gynecology, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Obstetrics and Gynecology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
BMC Pregnancy Childbirth. 2022 May 3;22(1):387. doi: 10.1186/s12884-022-04674-3.
To evaluate pregnancy outcomes and the risk of adverse obstetrical outcomes of cesarean myomectomy (CM) compared with cesarean section (CS) only, and to investigate the trend of surgeons in choosing CM.
A retrospective cohort study was performed on all patients who underwent CS complicated by leiomyoma at two university hospitals between January 2010 and May 2020. All patients were categorized into the CM (341 women) or CS-only (438 women) group. We analyzed the demographic factors, obstetric factors, surgical outcomes, and possible risk factors for adverse outcomes between the two groups.
Women who underwent CS only were significantly more likely to have a previous myomectomy and multiple leiomyoma history than women who underwent CM. The gestational age at delivery and pregnancy complications were significantly higher in the CS-only group. The mean size of the leiomyomas was larger in the CM group than in the CS-only group (5.8 ± 3.2 cm vs. 5.2 ± 3.1 cm, P = 0.005). The operation time and history of previous CS and preterm labor were higher in the CM group. The leiomyoma types differed between the two groups. The subserosal type was the most common in the CM group (48.7%), and the intramural type was the most common in the CS-only group. Patients in the CM group had fewer than three leiomyomas than those in the CS-only group. Preterm labor and abnormal presentation were relatively higher in the CM group than in the CS-only group, concerning leiomyoma presence. There were no significant differences in the preoperative and postoperative hemoglobin levels. The size of the leiomyoma (odds ratio [OR] = 1.162; 95% confidence interval [CI]: 1.07-1.25; P < 0.001) and operation time > 60 min (OR = 2.461; 95% CI: 1.45-4.15) were significant independent predictors of adverse outcomes after CM.
CM should be considered a reliable and safe approach to prevent the need for another surgery for remnant leiomyoma. Herein, surgeons performed CM when uterine leiomyomas were large, of the subserosal type, or few. Standardized treatment guidelines for myomectomy during CSs in pregnant women with uterine fibroids should be established.
评估剖宫产子宫肌瘤剔除术（CM）与单纯剖宫产（CS）相比的妊娠结局和不良产科结局风险，并调查外科医生选择 CM 的趋势。
对 2010 年 1 月至 2020 年 5 月期间在两家大学医院接受 CS 合并子宫肌瘤的所有患者进行回顾性队列研究。所有患者分为 CM（341 例）或 CS 仅（438 例）组。我们分析了两组之间的人口统计学因素、产科因素、手术结果和不良结局的可能危险因素。
与 CM 组相比，仅行 CS 的女性更有可能有先前的子宫肌瘤切除术和多发性子宫肌瘤史。CS 仅组的分娩时孕龄和妊娠并发症显著更高。CM 组的肌瘤平均大小大于 CS 仅组（5.8±3.2cm 比 5.2±3.1cm，P=0.005）。CM 组的手术时间和既往 CS 及早产史较高。两组的肌瘤类型不同。CM 组最常见的是浆膜下型（48.7%），CS 仅组最常见的是壁内型。CM 组的肌瘤少于三个的患者少于 CS 仅组。CM 组的早产和异常表现与 CS 仅组相比相对较高，与肌瘤存在有关。两组术前和术后血红蛋白水平无显著差异。肌瘤大小（比值比[OR] = 1.162；95%置信区间[CI]：1.07-1.25；P<0.001）和手术时间>60 分钟（OR = 2.461；95%CI：1.45-4.15）是 CM 后不良结局的显著独立预测因素。
CM 应被视为预防因残留子宫肌瘤而需要再次手术的可靠且安全的方法。在此，当子宫肌瘤较大、浆膜下型或较少时，外科医生会进行 CM。应制定在孕妇行 CS 时行子宫肌瘤切除术的标准化治疗指南。
