基于倾向性评分匹配法分析子宫肌瘤直径对剖宫产子宫肌瘤剔除术手术结局的影响OA

Objective:To investigate the impact of uterine fibroid diameter on the surgical outcomes of cesare-an myomectomy(CM).Methods:A retrospective cohort study was conducted to analyze the clinical data of 636 patients who underwent CM at the General Hospital of the Northern Theater Command of the People's Liberation Army between January 1,2020,and June 30,2024.Based on uterine fibroid diameter,patients were divided into di-ameter≥5 cm group(213 cases)and diameter<5 cm group(423 cases).Propensity score matching(1∶1)was performed,resulting in 416 successfully matched cases,with 208 cases in each group.Surgical outcomes were compared between the two matched groups,and the impact of prophylactic tourniquet application on surgical out-comes was analyzed for the diameter≥5 cm group.Results:①After matching,the intraoperative blood loss dur-ing CM was significantly higher in the group with fibroid diameter≥5 cm compared to the group with diameter<5 cm(310 ml vs.200 ml,P<0.05).The proportion of intraoperative tourniquet use was also higher in the diameter≥5 cm group than in the diameter<5 cm group(25.5%vs.1.9%,P<0.05).There were no statistically significant differences between the two groups in terms of operative time,postoperative hospital stay,or rate of fetal distress(P>0.05).Neither group experienced severe complications such as hysterectomy,bladder injury,or intestinal ob-struction.②Among patients in the diameter≥5 cm group,those who received a tourniquet(53 cases)had signifi-cantly less intraoperative blood loss compared to those who did not(155 cases),with a statistically significant difference(300 ml vs.380 ml,P<0.05).However,there were no significant differences in operative time,postoper-ative hospital stay,transfusion rate,postoperative fever,or fetal distress between the tourniquet and non-tourni-quet subgroups(P>0.05).Conclusion:Uterine fibroids with a diameter≥5 cm are associated with increased intr-aoperative blood loss during CM.Prophylactic application of a tourniquet effectively reduces intraoperative bleed-ing without prolonging the operative time.