较困难的腹腔镜子宫肌瘤剔除术——附142例临床报告

Laparoscopic Myomectomy for Relatively Difficult Cases:Analysis of 142 Cases

目的探讨腹腔镜进行较大及特殊部位子宫肌瘤剔除术的可行性、安全性。方法2003年3月-2008年6月,对142例肌瘤直径≥10 cm、后壁近宫颈处肌瘤、宫颈肌瘤、阔韧带肌瘤行腹腔镜子宫肌瘤剔除术。视肌瘤大小、部位的不同采取如下方法：①直接切开肌层剥出瘤体,较大肌瘤梭形切开瘤体肌壁,后壁肌瘤纵切或由远至近斜行向上切开;②较大的肌瘤可剥出部分瘤体后旋切碎解瘤体取出,剩下较小部分再完全剥出;③表面血管丰富的较大肌瘤或浆膜下肌瘤可采用套扎法;④阔韧带肌瘤则打开阔韧带牵出瘤体,旋切碎解至较小瘤体后于根部拧断。结果除1例采取腹腔镜辅助腹壁小切口剥除子宫肌瘤外,141例在腹腔镜下完成。剥除肌瘤标本重44-1903 g。手术时间30-175 m in。术中出血10-800 m。l无严重并发症发生。68例随访至术后2年,B超提示肌瘤复发2例。结论随着手术技术的提高,可以放宽腹腔镜子宫肌瘤剔除术的指征。

Objective To investigate the feasibility and safety of laparoscopic myomectomy in patients with large uterine myoma and the tumor located at special sites. Methods A retrospective study of 142 patients underwent laparoscopic myomeetomy was done. In the patients, all the myomas were ≥ 10 cm in diameter;located at the cervix, uterus posterior wall near to the isthmic uteri, or broad ligament. The procedure was completed according to the volume and location of the tumors. For large myomas, the muscle layer was resected to remove the tumor, after removing the major part of the lesion （cut into pieces before moving out）, the rest small parts were cut completely. Ligation was used for large tumors with sufficient blood supply in the surface or subserous myomas. For the myomas located in the broad ligament, the ligament was opened to pull out the tumor, and then the tumor was cut into pieces and resected at the root. Results The procedure was completed by laparoscopy in all of the patients, except in one who received laparoscopy-assisted resection. The removed tumors weighed 44 to 1903 g. The operation time ranged from 30 to 175 minutes. Intraoperative blood loss was 10 to 800 ml. No serious complications occurred. Among the cases, follow-up was available in 68 patients for 2 years. During the period, uhrasonography showed recurrent myoma in 2 patients. Conclusions With the improvement of the skills of laparoscopic myomectomy, indications for the laparoscopic operation can be widened.