探讨合并剖宫产术史患者阴式子宫肌瘤剔除术的手术技巧，并评价其安全性和有效性。

选择2008年1月至2011年1月因子宫肌瘤合并剖宫产术史在本院接受阴式子宫肌瘤剔除术(均含前穹窿途径)的患者14例纳入研究组。对其施行水分离＋锐性分离的阴式子宫肌瘤剔除术。将同期无剖宫产术史，在本院接受常规阴式子宫肌瘤剔除术的43例患者，纳入对照组(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准，得到该委员会批准)。对两组患者的手术情况、术中及术后并发症及术后恢复和随访情况进行对比分析。两组患者年龄、体重、子宫肌瘤数目和直径比较，差异无显著意义(P>0.05)。

研究组14例患者手术顺利，无膀胱、输尿管和肠管等盆腔脏器损伤，无血肿及盆腔感染等并发症发生，术后随访恢复良好。两组手术时间、术中出血量、术后排气时间、术后体温恢复正常时间、住院时间等比较，差异无显著意义(P>0.05)。

对合并剖宫产术史患者行阴式子宫肌瘤剔除术，打开前穹窿时采用水分离＋锐性分离方法可获满意结果。

To study the safety and efficacy of surgical technique of vaginal myomectomy in patients with cesarean section.

From January 2008 to January 2011, 14 patients (study group) with the history of cesarean section and uterine fibroids received vaginal myomectomy (all to contain the anterior fornix). The surgical technique was sharp dissection and hydrodissection. At the same time, 43 patients with uterine fibroids but without the history of cesarean section who underwent traditional vaginal myomectomy were included into control group. There had no significant difference of age, body weight, hysteromyoma pieces, diameter of hysteromyoma between two groups (P>0.05). Intraoperative and postoperative situations, complications, postoperative recovery, followed-up between two groups were analyzed. The procedure of this study was consistent with ethical standard established by the committee of investigation in human beings of Mianyang People's Hospital. And it was approved by this committee. Patients were informed of grouping and their written informed consent was obtained before clinical studies.

The operations were successful in study group with no bladder, ureter, bowel and pelvic organ injury or other complications. They were followed up for a good recovery. No significant difference were found in duration of operation, intraoperative blood loss, hospital stay, anal exhaust time, postoperative body temperature returned to normal between two groups (P>0.05).

Vaginal myomectomy which used sharp dissection and hydrodissection to the patients with the history of cesarean section can obtain satisfactory results.