腹腔镜与开腹子宫肌壁间肌瘤剔除手术的比较

Comparison between Laparoscopic and Open Myomectomies for Intramural Myoma

目的探讨腹腔镜在子宫肌壁间肌瘤剔除术中的临床应用价值。方法2006年1月～2007年12月对120例子宫肌壁间肌瘤按随机数字表法分组并征求患者同意后,52例行腹腔镜下子宫肌瘤剔除术(腹腔镜组),68例行开腹子宫肌瘤剔除术(开腹组),对2组手术时间、术中出血量、术后病率、并发症、住院时间、术后随访情况进行比较。结果手术时间腹腔镜组长于开腹组[(106.3±54.9)minvs(66.5±7.3)min,t=5.918,P=0.000];术中出血量腹腔镜组略少于开腹组[10～300ml(中位数50ml)vs20～200ml(中位数50ml),Z=-1.998,P=0.046];术后病率腹腔镜组显著低于开腹组[7.7%(4/52)vs30.9%(21/68),χ2=9.608,P=0.002];并发症发生率腹腔镜组与开腹组相似[3.8%(2/52)vs8.3%(3/36),χ2=0.000,P=1.000];住院时间腹腔镜组明显短于开腹组[(7.5±1.4)dvs(10.4±1.2)d,t=-12.201,P=0.000];术后随访时间腹腔镜组与开腹组相似[(9.7±2.3)月vs(9.6±1.8)月,t=0.267,P=0.790],均无复发;腹腔镜组术后月经恢复正常率与开腹组相似[94.4%(17/18)vs90.5%(19/21),χ2=0.000,P=1.000]。结论腹腔镜下子宫肌壁间肌瘤剔除术与开腹手术相比效果无差异,术后恢复优于开腹手术,是一种理想的手术方式。

Objective To evaluate the value of laparoscopy in the treatment of intramural myoma.Methods Totally 120 cases of intramural myoma were randomly divided into laparoscopy（n=52）and open groups（n=68）.Clinical data,including operation time,intraoperative blood loss,rates of postoperative pyrexia and postoperative complications,length of hospital stay and follow-up,were compared between the two groups.Results Compared to the open group,the laparoscopy group had significantly longer operation time （106.3±54.9）min vs（66.5±7.3）min,t=5.918,P=0.000],less blood loss 10-300 ml（median,50 ml）vs 20-200 ml（median,50 ml）,Z=-1.998,P=0.046],lower rate of postoperative pyrexia 7.7%（4/52）vs 30.9%（21/68）,χ2=9.608,P=0.002],similar rate of postoperative complications 3.8%（2/52）vs 8.3%（3/36）,χ2=0.000,P=1.000],shorter hospital stay （7.5±1.4）d vs（10.4±1.2）d,t=-12.201,P=0.000],and similar length of follow-up （9.7±2.3）months vs（9.6±1.8）months,t=0.267,P=0.790] and rate of normal menses 94.4%（17/18）vs 90.5%（19/21）,χ2=0.000,P=1.000].Conclusions Laparoscopy is as effective as open surgery for intramural myoma.While the laparoscopy leads to better postoperative recovery than the open surgery.