大子宫肌瘤腹腔镜下剥除术的可行性与安全性

A Study on the Feasibility and Safety of Laparoscopic Excision of Large Hysteromyoma

目的前瞻性研究最大直径＞5 cm的子宫肌壁间肌瘤、黏膜下肌瘤[已经占据全部宫腔,无法行经宫颈子宫肌瘤电切术(TCRM)者]、子宫阔韧带内肌瘤及多发性子宫肌瘤腹腔镜下瘤体切除术的可行性及安全性.方法术前B超检查,仔细确认肌瘤位置、数目、大小,测量肿瘤最大直径.采用容积法测定出血量.手术方法:切开肌瘤包膜,剔除瘤核,缝合创面.对手术时间、术后出血量、术后并发症等进行观察.术后定期随访.结果可供分析病例102例,肌瘤类型:多发性肌瘤33例,单发肌瘤69例.肌壁间肌瘤29例,其中单发肌瘤13例,最大直径5～12 cm,平均(7.6±2.0)cm;多发肌瘤16例,肌瘤数目2～14个,平均4.9个,最大直径3～8.5 cm,平均(5.2±1.5)cm.浆膜下肌瘤61例,其中单发肌瘤44例,最大直径6～15 cm,平均(8.2±2.5)cm;多发肌瘤17例,肌瘤数量2～14个,平均4.0个,最大直径2～10 cm,平均(4.9±2.1)cm.阔韧带内肌瘤8例,均为单发;最大直径7～12 cm,平均(8.1±0.9)cm.黏膜下肌瘤4例,均为单发;最大直径8～10 cm,平均(8.7±0.5)cm.手术结局:腹腔镜肌瘤剥除101例,腹腔镜辅助下腹小切口肌瘤剥除1例,无中转开腹及改行子宫全切除术者.手术时间30～240 min,平均(87.2±43.1)min.术中出血量5～400 mL,平均(53.6±56.6)mL.近期疗效:完全切净100例,基本切净2例.术中术后并发症:皮下气肿3例,皮下血肿1例(双侧腹壁/腰骶部淤血),穿刺孔感染1例.结论大子宫肌瘤及多发性子宫肌瘤腹腔镜下剥除是可行的,该术式对术者的技术熟练程度有较高要求,应该注意手术适应证的选择.

ABSTRACT： Objective To study the feasibility and safety of laparoscopic excision of large and mukl-hysteromyoma. Methods To evaluate the location, size and the number of myoma by ultrasound preoperation. The amount of hemorrhage was evaluated by volume. Surgical technique： To cut through the envelope of the myoma, resect myoma, and suture the uterus wall. Followed the patients regularly. Results 102 patients were evaluated. There were 33 muti-myoma and 69 mono-myoma. There were 29 cases of intramural myoma, including 13 mono-myoma,± with maximum tumor size in diameter 5 - 12 cm, mean （7.6 ± 2.0）cm; 16 muki-myoma, the number of myoma was 2- 14, mean 4.9, with maximum tumor size in diameter 3 -8.5 cm, mean （5.2 ± 1.5）cm. There were 61 subserous myoma, 44 mono with maximum tumor size in diameter 6- 15 cm, mean （8.2 ± 2.5） cm, 17 multiple, the number of myoma was 2 - 14, mean 4.0 with maximum tumor size in diameter 2 - 10 cm, mean （4.9 ± 2.1 ）cm; 8 intra-broad ligament, with maximum tumor size in diameter 7- 12 cm, mean （8.1 ± 0.9）cm. 4 submucous, maximum tumor size in diameter 8- 10 cm, mean （8.7 ± 0.5）cm. The outcome of operation： 101 cases of laparoscopic myomectomy were performed and 1 cases of mini-abdominal incision myomectomy with assisted laparoscopy no alternative to laparotomy, no case changed to total hysterectomy. Duration of operation： 30-240 min, mean （87.2 ± 43.1 ）rain. Blood loss during the operation： 5- 400 mL, mean （53.6 ± 56.6）mL. Short term effectiveness： Complete resection 100 cases, nearly complete resection 2 cases, partial resection 0. Complications： pneumoderma 3 cases, hemorrhage post-operation 0 case, subcutaneous hematoma 1 case, infection 1 case. Conclusion Laparoscoplc resection of the large and multi-myoma is feasible and safe. The OBGY doctors should pay more attention to the indications of laparoscopic hysteromyomectomy.