免气腹腹腔镜肌壁间子宫肌瘤剔除术65例临床分析

Clinical study of gasless laparoscopic intramural myomectomy-A report of 65 cases

目的探讨免气腹腹腔镜下肌壁间子宫肌瘤剔除术的临床价值。方法将2004年3月～2006年5月该院妇科实施免气腹腹腔镜下子宫肌瘤剔除术患者的临床资料进行回顾性分析。结果65例均完整剔除肌瘤,无1例中转进腹手术。术中出血量(146±110.7)mL,手术时间(86.5±27.7)min,术后肛门排气时间(15±7.2)h。无严重手术并发症。单发肌壁间子宫肌瘤最大径、不同部位子宫肌瘤(前壁、后壁、宫底部)、多发性子宫肌瘤组肌瘤数2个者与<6cm单发性肌壁间肌瘤,其术中出血量和手术时间比较差异均无显著性。多发性子宫肌瘤组肌瘤数2个者与≥3个者比较,其术中出血量和手术时间比较差异有显著性。结论免气腹腹腔镜下子宫肌瘤剔除术对机体损伤小、恢复快,尤其方便在腹腔镜下缝合,更适合应用于子宫肌瘤剔除术。

[Objective] To study the clinicle value of gasless laparoscopic intramural myomectomy. [Methods] 65 patient who underwent gasless laparoseopie myomeetomy in our department from Mar 2004 to May 2006 were retrospectively analyzed. [Results] 65 eases of intramural myoma were treated with gasless lapaeoseopic myomeeto- my and no ease was changed to transabdominal myomectomy. The mean bleeding amount was （146±110.7） mL, The mean operative time was （86.5±27.7） rain and the recovery time of gastrointestinal ruction was （15±7.2） h. No serious complication was found. There were no signifieative difference in bleeding amount and operative time between single myoma size≥6 cm and〈6 cm, different part myoma ,multimyoma that the number of myoma was two and single myoma size 〈6 era. Bleeding amount and operative time of two myoma in uretus were signifieativly less then that of ≥3 myoma in uretus. [Conclusion] It suggests that gaslees laparoscopie myomeetomy is safe and convenient with little blood loss and short recovery in treating intramural myoma. Gaslees laparoseope is supposed to be a feasible technique in intramural myomeetomy.