腹腔镜与开腹子宫肌瘤剔除术的比较

A comparison of open and laparoscopic myomectomy

目的探讨腹腔镜下子宫肌瘤剔除术的临床应用价值。方法对2002年12月-2005年2月腹腔镜（n=185）与开腹（n=69）子宫肌瘤剔除术2组患者手术时间、术中出血量、术后体温恢复正常时间、肠功能恢复时间和住院日等进行对比分析。结果腹腔镜组2例因止血困难中转开腹。腹腔镜组手术时间（81．3±14．7）min，与开腹组的（77．2±18．1）min无显著差异（t=1．849，P=0．066）；腹腔镜组术中出血量（101．5±36．7）ml，少于开腹组的（154．5±61．1）ml（t=-8．397，P=0．000）；腹腔镜组术后肠功能恢复时间（13．8±5．4）h，短于开腹组的（23．3±6．0）h（t=-12．074，P=0．000）；腹腔镜组术后体温恢复正常时间（2．7±0．8）d，短于开腹组的（3．8±1．0）d（t=-9．064，P=0．000）；腹腔镜组术后住院时间（6．0±1．5）d，短于开腹组的（8．0±2．0）d（t=-8．575，P=0．000）。腹腔镜组152例随访（13．2±8．7）月，复发17例（11．2％），57例不孕者中术后1年内妊娠17例（29．8％）；开腹组48例随访（12．5±7．9）月（t=0．511，P=0．610），复发8例（16．7％）（x^2=1．003，P=0．317），不孕16例中术后1年4例妊娠（25．0％）（x^2=0．004，P=0．949），均无显著差异。结论腹腔镜下子宫肌瘤剔除术具有创伤小，术中出血少，术后恢复快及住院时间短等优点，但有一定手术适应证，不能完全取代开腹手术。

Objective To discuss the clinical value of laparoscopic myomectomy. Methods We compared clinical data of laparoscopic myomectomy （Laparoscopic Group, n = 185） with open myomectomy （ Open Group, n = 69）, from December 2002 to February 2005, in respect of operative time, hemorrhage volume, time to normal temperature, recovery time of bowel movement, and duration of hospital stay. Results Conversions to open surgery were required in 2 cases in the Laparoscopic Group because of difficulties of hemostasis. There was no significant difference in the operative time （ t = 1. 849, P = 0. 066） between the Laparoscopic Group （81.3 ± 14.7 min） and the Open Group （77.2 ± 18.1 rain）. The intraoperative hemorrhage volume was significantly less in the LaparoscopicGroup （101.5 ±36.7 ml） than in the Open Group （154.5 ±61.1 ml） （t = -8.397,P=0.000）. Shorter time to normal temperature, recovery time of bowel movement, and hospital stay were achieved in the Laparoscopic Group （2.7 ± 0.8 d; 13.8 ± 5.4 d ; 6.0 ± 1.5 d） than in the Open Group （3.8 ± 1.0 d ; 23.3 ± 6.0 d ; 8.0 ± 2.0 d）, with significant difference （ t = - 9.064, P = 0. 000 ; t = - 12. 074, P = 0. 000 ; t = - 8. 575 ,P = 0. 000）. Follow-ups were conducted in 152 cases in the Laparoscopic Group for 13.2 ± 8.7 months, which revealed 17 cases of recurrence （ 11.2% ） and 17 cases of pregnancy within 1 year out of 57 cases of infertility （29.8%）. As compared with the Laparoscopic Group, follow-ups were conducted in 48 cases in the Open Group for 12.5 ± 7.9 months （t =0.511,P=0.610）, which revealed 8 cases of recurrence （16.7%; x^2 = 1.003, P =0.317） and 4 cases of pregnancy within 1 year out of 16 cases of infertility （25.0% ; x^2 = 0. 004, P = 0. 949）. Conclusions Laparoscopic myomectomy has advantages of micro-invasion, little blood loss, rapid postoperative recovery, and short hospitalization. However, it cannot entirely supersede the open myomectomy.