腹腔镜下子宫动脉上行支阻断术辅助子宫肌瘤剔除术的疗效观察

Efficacy of combining the bipolar coagulation of ascending uterine arteries and laparoscopic myomectomy

目的:评估腹腔镜下子宫动脉上行支阻断术辅助下行子宫肌瘤剔除术的临床疗效。方法:应用腹腔镜下子宫肌瘤剔除术治疗124例子宫肌瘤患者,其中观察组63例在行子宫肌瘤剔除前先行子宫动脉上行支阻断,然后行子宫肌瘤挖出术,对照组61例仅行子宫肌瘤剔除术。结果:观察组术中出血量(64.20±22.78)mL,对照组为(95.52±25.82)mL;观察组手术时间为(55.08±10.65)min,对照组为(62.70±12.58)min,两组比较差异有显著性(P<0.001)。观察组术后排气时间早于对照组(P<0.001);术后住院时间两组比较无显著差异(P>0.05)。术后发热病例两组比较差异无统计学意义(P>0.05);对照组术后腹痛的病例高于观察组(P<0.05)。术后随访两组月经改善情况比较差异无统计学意义(P>0.05)。结论:子宫动脉上行支阻断可减少腹腔镜下子宫肌瘤剔除时的手术出血量,术后恢复快,且不增加手术并发症,具有临床推广应用价值。

Objective To evaluate the clinical effect of the bipolar coagulation of ascending uterine arteries combined with laparoscopic myomectomy. Methods 124 cases of uterine leiomyomas （except cervix myoma, intraligamentary myoma, submucosa myoma） underwent laparoscopic myomectomy. 63 cases underwent bipolar coagulation of ascending uterine arteries before myomectomy served as research group; the other 61 cases served as control group, which underwent myomectomy only. Results The duration of operation in research group（55.08 ± 10.65） min was less than that in control group （62.70 ± 12.58）min,and the volume of blood loss in research group （64.20 ± 22.78）mL was less than that in control group（95.52 ± 25.82）mL（P 〈 0.001）. All wounds were well healed in both groups. The time of postoperative passage of flatus in research group （15.52 ：t： 4.21h） was earlier than that in control group （17.78 ±4.28）h （P 〈 0.001 ）. There was no significant difference in the mean length of stay between two groups （P 〉 0.20）. 15（23.8%）eases had fever in research group and 23 （37.7%） cases had fever in control group after operation, but there was no significant difference between two groups （P 〈 0.05 ）. The occurrence rate of abdominal pain in research group （11.1% ） was lower than that in control group （29.5%） （P 〈 0.025）. All patients were followed up for 24 to 36 months. The rate of hypermenorrhea improvement was 100% （26/26）in research group, and that in control group was 93%（16/20）, there was no significant difference between two groups （P 〉 0.05）. All patients resumed menstruation in two months after operation. The first menstruation time in research group was later than that in control group （P 〈 0.05）.There was no significant difference in the rate of normal menstruation resumption between two groups （P 〉 0.50）. 1 case （ 1.6% ） had myoma recurred 15 months after operation, 8 cases （ 13.1% ） recurred 12 to 24 months after operation.There was significant difference in the rate of recurrence （P 〈 0.05）. Conclusions The bipolar coagulation of ascending uterine arteries before laparoscpoc myomeetomy obviously decreases the intraoperative blood loss and operation time. It presents less operative complications. It may be able to prevent the relapse of myomas.