腹腔镜辅助子宫肌瘤剔除术对不孕患者生殖预后的影响

The effect of laparoscopic-assisted myomeetomg on the reproductive prognosis of infertility

目的观察腹腔镜辅助子宫肌瘤剔除术的可行性、安全性及对不孕症患者生殖预后的影响。方法选择单纯子宫浆膜下或肌壁间肌瘤因素引起的不孕患者71例为研究组,同期肌瘤大小、数量、部位相匹配,气腹法腹腔镜手术的72例为对照组。观察两组手术时间、术中出血量、术后恢复、住院天数,术后肌瘤复发、妊娠和分娩的情况。结果两组患者共143例手术均顺利完成,成功率为100%。LAM组患者的手术时间较LM组明显缩短,术中出血量也较少,两组比较差异有显著性(P<0.05)。而术后患者肠功能恢复、平均住院天数两组均相似,差异无显著性(P>0.05)。LAM组妊娠40例(56.3%),自然流产4例(10.0%),早产2例(5.6%),剖宫产24例(66.7%)。LM组妊娠39例(54.2%),自然流产5例(12.8%),早产3例(8.8%),剖宫产25例(73.5%),两组患者妊娠及分娩期均顺利,无子宫破裂发生,相比较差异无显著性(P>0.05)。LAM组的1年、3年和平均肌瘤复发率均明显低于LM组的患者,分别为4.2%(3/71)、11.3%(8/71)、7.0%(5/71)与15.3%(11/72)、25.0%(18/72)、19.4%(14/72),两组相比差异有显著性(P<0.05)。结论腹腔镜辅助子宫肌瘤剔除术可行安全,临床易于操作,微创去除肌瘤后重建的子宫妊娠预后良好,值得在基层医院推广。

Objective： To investigate the feasibility, security of laparoscopic - assisted myomectomy and the effect on the repro- ductive prognosis of infertility. Methods ： Seventy - one patients of infertility, simply caused by subserous myoma or intramural myoma were selected as control group （group LAM） . In the same period. Another seventy- two patients were selected as comparison group, whose myoma of uterus＇size, number and site were matched with group LAM. Recording such things as the time of operation, bleeding volume, recovery, hospital stays, the recurrence of myoma of uterus, pregnancy and delivery. Results- All of 143 eases were opera- ted successfully. The operation time of group LAM was significantly shorter than that of group LM, bleeding volume was much little than group LM （ P 〈 0. 05） . But there were no significant differences in the recovery of bowel movement and mean hospital stays （ p 〉0. 05） . In LAM group, pregnancy 40 （56. 3% ）, spontaneous abortion 4 （ 10. 0% ）, premature delivery 2 （5. 6% ）, cesarean section 24 （ 66. 7% ） In LM group, pregnancy 39 （ 54. 2% ）, spontaneous abortion 5 （ 12. 8% ）, premature delivery 3 （8. 8% ）, cesarean section 25 （73.5%） . There was no rupture of uterus （ P 〉0. 05） .The recurrence incidence of 1 year, 3years and mean rate in group LAM was significantly shorter than that of group LM, 4. 2% （3/71）, 11.3% （ 8/71 ）, 7.0% （5/71）, 15.3% （ 11/72）, 25. 0% （＇18/72）, 19.4% （ 14/72）, （ P 〈 0. 05 ） . Conclusion： Laparoseopie - assisted myomeetomy is easy to operate for the most hospital and has a good reproductive prognosis for infertility.