腹腔镜下子宫动脉阻断术联合肌瘤挖出术治疗阔韧带肌瘤的临床应用

Clinical application of laparoscopic uterine artery occlusion combined with myomectomy to broad ligament myomas

目的探讨腹腔镜下子宫动脉阻断术联合肌瘤挖出术治疗阔韧带肌瘤的临床可行性和安全性。方法回顾性分析在该院妇科接受手术的58例阔韧带肌瘤患者的临床资料,所有患者均采用LUAO-M的手术方式。在腹腔镜下分离解剖子宫动脉主干,用双极电凝或PK刀闭合子宫动脉,然后电针切开肌瘤表面包膜,使用剥离器剥离、挖出肌瘤,合成线单层连续缝合子宫表面浆肌层切口。结果平均手术时间(96.4±18.3)min,平均出血量为(78.6±32.7)mL,术后最高体温为(37.8±0.3)℃,术后病率5.2%(3例),术后住院天数(7.6±2.5)d,术后发生皮下气肿2例、下肢深静脉血栓1例,无其他严重并发症(如盆壁大血管及输尿管损伤)发生。结论LUAO-M治疗子宫阔韧带肌瘤在临床应用中是安全可行的。

[ Objective ] To explore the clinical feasibility and safety of laparoscopic uterine artery occlusion combined with myomectomy （LUAO-M） for treatment of broad ligament myomas. [ Methods] The uterine artery was isolated and occluded with Klcppinger bipolar forceps （Sabre 2400, ASPEN LABS USA） or PK forceps （Gyrus Medical Limited Inc UK） under laparoscope. Then dissection was performed on the surface of pseudo capsule with Kleppinger unipolar needle （Sabre 2400, ASPEN LABS USA） or PK needle （Gyrus Medical Limited Inc UK）, the target myoma was stripped out of the tumor bed with a dissector. Repair of the incision was carried out in one layer with interrupted single stitch by Absorbable VICRYL suture （Johnson VICRYL ETHICON USA）. A total of 58 patients with broad ligament myomas were treated by the procedure of LUAO-M in Centre Hospital of Yangpu from October 2001 to July 2007, their clinical data were retrospectively analyzed and the procedure of LUAO-M was evaluated. [Results] The operative time was （96.4±18.3） minutes, the mean blood loss was （78.6±32.7） mL, the highest postoperative temperature was （37.8±0.3）℃ and the postoperative morbidity was 5.2% （3/58）. The duration of hospital stay after operation was （7.6±2.5） days. Complications included two cases of subcutaneous emphysema, one case of deep venous thrombosis of the lower limb. No patient had uretal trauma or large vessel injury. [ Conclusion] The surgical treatment of LUAO-M for broad ligament myomas is feasible and safe.