经腹、经阴道与腹腔镜下子宫肌瘤剔除术的比较分析

A comparison of abdominal,vaginal and laparoscopic myomectomy

目的比较经腹、经阴道和腹腔镜下3种子宫肌瘤剔除术的特点,指导临床术式的选择。方法比较经腹子宫肌瘤剔除术147例(开腹组)、腹腔镜下子宫肌瘤剔除术128例(腹腔镜组)和经阴道子宫肌瘤剔除术86例(阴式组)3组患者的手术时间、术中出血量、术后体温恢复正常时间、术后排气时间和术后住院时间。结果阴式组手术时间最短,为(58.6±10.7)min,开腹组手术时间(87.9±21.4)min与腹腔镜组(96.7±26.2)min比较差异无显著性(P>0.05);术中出血量阴式组最少,为(51.9±16.7)mL,腹腔镜组次之,为(102.4±34.7)mL,均少于开腹组(153.6±56.6)mL(P<0.05);术后体温恢复正常时间阴式组(66.2±17.8)h,与腹腔镜组(65.8±19.2)h比较差异无显著性(P>0.05),均短于开腹组(93.2±24.3)h(P<0.05);术后排气时间阴式组最短,为(19.7±7.5)h,腹腔镜组次之,为(24.3±6.9)h,均短于开腹组(31.6±7.4)h;术后住院时间阴式组(5.8±1.6)d与腹腔镜组(6.1±1.7)d比较差异无显著性(P>0.05),均短于开腹手术组(8.3±2.1)d(P<0.05)。结论腹腔镜下和经阴道子宫肌瘤剔除术与经腹子宫肌瘤剔除术相比具有创伤小、术中出血少、术后恢复快及住院时间短等优点。但3种术式特点和适应证不同,不能完全互相替代。

[Objective] To compare the characteristics of abdominal, vaginal and laparoscopic myomectomy, and to provide valuable information for choosing approach of myomectomy. [Method] We compared outcomes of abdominal myomectomy （Open Group, n =147）, laparoscopic myomectomy （Laparoscopic Group, n =128） and vaginal myomectomy （Vaginal Group, n =86） in respect of operative time, hemorrhage volume, time to normal temperature, recovery time of bowel movement, and discharge time after operation. [Result] The mean operative time of Vaginal Group （58.6±10.7） min was the shortest （P 〈0.05） and there was no significant difference between Open Group （87.9±21.4） rain and Laparoscopic Group （96.7±26.2） rain. The mean hemorrhage volume intraoperation was significandy less in the Vaginal Group （51.9±16.7） mL and Laparoscopic Group （102.4±34.7） mL than in the Open Group （153.6±56.6） mL （P 〈0.05）. Shorter time to normal temperature, recovery time of bowel movement, and discharge time after operation were achieved in the both Vaginal Group （66.2h±17.8） h; （19.7h±7.5） h; （5.8±1.6） d and Laparoscopic Group （65.8±19.2） h; （24.3±6.9） h; （6.1±1.7） d than in the Open Group （93.2±24.3） h; （31.6±7.4） h; （8.3± 2.1）d, with significant difference （P 〈0.05）. [Conclusion] Vaginal myomectomy and laparoscopic myomectomy have advantages of micro-invasion, little blood loss, rapid postoperative recovery, and short hospitalization. However, these three approaches had their characters and indications respectively. They could not entirely supersede each other.