腹腔镜肌壁间子宫肌瘤剔除术中不同止血方法的评价

Assessment of different homeostatic methods used in iaparoscopic intramural myomectomy

目的评价临床常用腹腔镜肌瘤剔除术中止血方法的有效性和安全性，寻找简便有效的止血方法。方法将有手术指征的肌壁间子宫肌瘤患者280例随机分成4组，每组70例，分别采用肌瘤蒂部套扎、肌瘤周围肌层注射12IU垂体后叶素、肌瘤周围肌层注射20IU缩宫素加蒂部套扎及合用垂体后叶素和蒂部套扎4种止血方法。结果4组患者术中出血量分别为（171±146）、（115±70）、（184±140）和（106±73）ml，使用垂体后叶素12IU局部注射的2组患者术中出血量明显少于单独套扎或注射缩宫素组（P〈0．01）。合用垂体后叶素和蒂部套扎法术后住院时间明显短于其他3组[（2．9±0．5）d比（3．1±0．7）d、（3．6±0．8）d和（3．3±0．7）d，P〈0．05]。合用垂体后叶素和蒂部套扎法组比缩宫素组术后肛门排气时问短[（19．7±5．8）h比（25．9±8．6）h，P〈0．05]，血红蛋白含量下降较少[（1．1±0．9）g／L比（1．5±1．0）g／L，P〈0．05]。结论12IU垂体后叶素肌瘤蒂部注射联合肌瘤蒂部套扎可以明显减少术中出血，加快术后恢复，无明显全身副作用，是简单有效的腹腔镜下肌壁间肌瘤剔除术辅助止血方法。

Objective To explore the safe and effective method of hemostasis in laparoscopic hysteromyomectomy （LM）. Methods Two hundred and eighty women with symptomatic uterine intramural fibroids undergoing LM were assigned to 4 groups, Group A undergoing fibroid pedicle ligation, Group B injected with 12 IU diluted vasopressin around the myoma, Group C injected with 20 IU oxytocin combined with pedicle ligation, and Group D injected with vasopressin combined with pedicle ligation. The operation time, amount of blood loss, operative complications, bowel deflation, post-operative hemoglobin dropping, and length of hospital stay were compared. Results The amounts of blood loss of Groups A and C were （171 ±146） ml and （184 ± 140）ml, both significantly higher than those of Groups B and D [（115 ±70） mland （106±73）ml, both P〈0.01]. The length of hospital stay of Group D was （2.9 ±0.5） d, significantly shorter than those of GroupsA, B, and C [（3.1 ±0.7） d, （3.6±0.8） d, and （3.3 ± 0.7） d, all P 〈 0.05 ]. The bowel deflation time of Group D was （ 20 ± 6） h, significantly shorter than those of the Groups A, B, and C [ （26 ± ） h, （25 ~7） h, and （25 ± 8） h respectively, all P 〈0.05]. The post-operative hemoglobin dropping of group D was （ 1.1 ± 0.9 ） g/L, significantly less than those of GroupsA, B, andC [（1.5±1.0） , （1.4±0.8）, and （1.2 ±0.7） g/Lrespectively, all P〈0.05]. Conclnsions Vasopressin （ 12 IU） injection around the myoma is a simple, effective, and safe homeostatic procedure during LM. Pedicle ligation can reduce advanced post-operative bleeding post-operation.