阴式与腹式子宫黏膜下肌瘤剔除术的比较

Comparison between Vaginal and Abdominal Myomectomy

目的探讨阴式子宫黏膜下肌瘤剔除术的临床应用价值。方法我院2005年3月～2008年5月因异常子宫出血经宫腔镜联合B超检查诊断为子宫黏膜下肌瘤78例,肌瘤均位于子宫下段,肌瘤直径30～63mm。行宫腔镜切除失败后,改行阴式子宫肌瘤剔除术36例(阴式组),改行腹式子宫肌瘤剔除术42例(开腹组),比较2组手术时间、术中出血量、术后住院时间与术后恢复情况。结果阴式组36例成功完成手术,手术时间(64.7±10.4)min,显著短于开腹组(71.7±11.3)min(t=-2.829,P=0.006);阴式组术中出血量(200.0±38.4)ml,显著少于开腹组(253.6±47.6)ml(t=-5.412,P=0.000);阴式组术后肛门排气时间(18.5±4.3)h,显著短于开腹组(30.9±4.7)h(t=-12.078,P=0.000);阴式组术后住院时间(4.9±1.2)d,显著短于开腹组(7.0±1.3)d(t=-7.368,P=0.000)。2组术后随访3～40个月,平均28个月,随访未见肌瘤复发,术后满意率达100%,2组妊娠率差异无统计学意义[2.8%(1/36)vs4.8%(2/42),χ2=0.000,P=1.000]。结论对于宫腔镜无法切除的子宫下段较大黏膜下肌瘤(肌瘤直径≥30mm),阴式子宫肌瘤剔除术较传统开腹手术具有术中出血少、术后恢复快、住院时间短、并发症少等优点。

Objective To investigate the clinical value of vaginal myomectomy. Methods From March 2005 to May 2008, 78 women with abnormal uterine bleeding were diagnosed with submucous myoma by hysteroscopy combined with uhrasonography. All the myomas were located in the lower uterine segment, and the diameter of the tumor ranged from 30 mm to 63 mm. The patients were divided into two groups to underwent vaginal myomectomy （vaginal group, 36 cases） or abdominal electrotomy （open group, 42 cases）. The operation time, intraoperative blood loss, postoperative hospital stay and recovery of the two groups were compared. Results The vaginal operation was accomplished in all of the 36 cases. Compared with the open group, the vaginal group had significantly shorter operation time [（64.7±10.4） min vs （71. 1 ±11.3） min, t = -2.599,P =0.011], less intraoperative blood loss [（200.0 ±38.4） ml vs （253.6 ±47.6） ml, t = -5. 412, P=0. 000],quicker recovery of bowel movement [（18.5 ±4.3） h vs （30.9±4.7） h, t= -12.078, P=0. 000], and shorter postoperative hospital stay [（4.9-±1.2） d vs （7.0±1.3） d, t = -7. 368, P =0. 000]. Follow-up was available in all of the 78 cases for 3 to 40 months （mean, 28 months） , during which no relapse occurred, and no statistieal differences in pregnancy rate between the two groups was revealed [ 2.8% （1/36） vs 4.8% （2/42） , Χ^2 = 0. 000, P = 1. 000]. The operation satisfaction rates in both of the two groups were up to 100%. Conclusions Vaginal myomectomy has advantages in less hemorrhage, fast recovery, short postoperative hospital stay, and low complieation rate. For the tumors located in the lower uterine segment or those larger than 30 mm in diameter, vaginal myomeetomy is an alternative to hysteroseopie electrotomy.