腹腔镜下复杂子宫肌瘤剔除术的可行性分析

Feasibility study of laparoscopic complicate myomectomy:analysis of 67 cases

目的探讨腹腔镜下进行复杂子宫肌瘤剔除术的可行性。方法对67例多发、多部位的子宫肌瘤(即复杂子宫肌瘤)患者在腹腔镜下,使用输尿管红外线显示系统和(或)自制肌瘤分离棒,行子宫肌瘤剔除术,观察手术并发症、手术时间、术中出血量及术后恢复情况。其中多发子宫肌瘤(肌瘤≥5个)者29例,单发子宫肌瘤直径≥7 cm者23例(子宫肌壁间肌瘤19例,子宫浆膜下肌瘤4例),子宫阔韧带肌瘤6例,子宫颈肌瘤9例。剔除子宫肌瘤最多达17个,子宫肌瘤直径≥10 cm者11例,其中直径最大的达15 cm(为阔韧带肌瘤,重2100g)。结果所有病例手术均获成功,无一例中转开腹,无手术并发症发生。平均手术时间(114±32)min,平均术中出血量(114+78)ml,术后平均住院时间5．1d。子宫多发肌瘤、肌壁间肌瘤及宫颈肌瘤术中出血量及手术时间明显多于子宫阔韧带肌瘤及子宫浆膜下肌瘤,差异有统计学意义(P＜0．05)。结论复杂子宫肌瘤剔除术可在腹腔镜下完成,输尿管红外线显示系统的应用,扩大了腹腔镜子宫肌瘤剔除术的手术指征,手术器械的不断创新及熟练的手术技巧是手术成功的关键。

Objective To investigate the feasibility of complicate myomectomy. Methods Six- seven patients with complicated uterine myomas undergoing laparoscopic myomectomy were retrospectively analyzed. The myomectomy was done using ureteral infravision imaging system or/and with self-made myoma segregate-stick. Among the total, there are 29 cases of multiple myomas （the number of myomas ≥5） and 23 cases of single myoma （ the diameter of myoma≥7cm, including 19 cases of intramural myoma, 4 cases of subserous myoma）, 6 cases of myoma of broad ligament of uterus and 9 cases of cervical myoma. Results All cases were performed successfully laparoscopically. No intra-operative laparotomy or complications occurred. The average operating time and blood loss were （114 ±32） min and （114 ±78） ml respectively. The average time of hospital stay was 5. 1 d. The average operating time and blood loss in the group （including multiple myoma group, intramural myoma group and cervical myoma） were significantly exceeded the other groups （ including myoma of broad ligament of uterus group and subserous myoma group ） . Conclusions Laparoscopic complicate myomectomy can be performed and the operation indication is enlarged using Ureteral Infravision Imaging System. Advancement in surgical instruments and expert operating skills are the key to operation success.