腹腔镜下子宫肌瘤切除术54例临床分析

Laparoscopic myomectomy clinical analysis of 54 cases

目的探讨腹腔镜下子宫肌瘤切除术的手术指征、手术效果、手术技巧及手术并发症。方法对2004年8月-2006年7月在我院行腹腔镜下子宫肌瘤切除术的患者共54例进行回顾性分析,手术指征：膀胱压迫症状,肌瘤生长迅速,疼痛及无任何症状自愿要求手术的患者,所有患者均无月经改变。结果单个肌瘤33例,2个肌瘤12例,3个肌瘤9例,共切除肌瘤84个,其中壁间肌瘤27个,浆膜下肌瘤57个,肌瘤大小3-10cm,平均4.7cm,77个肌瘤切除后进行缝合,平均每例手术时间74min,平均每例出血量104ml,壁间肌瘤较浆膜下肌瘤手术时间及术中出血量均明显增加（P〈0.01）。每例平均住院时间为4.5d,术后1例发热。术后1个月复诊患者压迫症状明显改善,疼痛明显减轻。术后随诊24个月,9例失诊,其余45例中有2例复发,再次行腹腔镜下子宫次全切除术,术中未见明显粘连。结论中等大小单发的壁间肌瘤,浆膜下肌瘤,腹腔镜下肌瘤切除出血少,术后病率低,手术效果好,手术创伤小,术后恢复快,住院时间短。

Objective To evaluate laparoscopic myomectomy surgical indications,operative results, surgical techniques and postoperative complications. Methods From August 2004 to July 2006 in our hospital under laparoscopic myomectomy cases a total of 54 cases were retrospectively analyzed, surgical indications ： bladder compression symptoms, the rapid growth of fibroids, pain and voluntary request of any symptom-free patients the operation, all patients had no change in menstruation. Results 33 cases with a single fibroids, 12 cases of 2 fibroids ,9 cases of 3 fibroids, a total of 84 fibroids removed, of which 27 intramural fibroids,57 subserosal fibroids,the size of smallest fibroids is 3cm ,the maximum is 10cm, the average size is 4. 8cm,77 fibroids suture ,Intramural fibroids operation time and blood loss were significantly increased than subserosal fibroids（ P〈0.01 ）. Average hospitalization time was 4. 5 days, after a case of fever. Review after one month showed that patients with significant imprevement in symptoms of oppression, pain relief. Postoperative follow-up 24 months,9 cases of loss of service, and the 2 cases of other 45 cases have recurrence, operated once again under laparescopic hysterectomy,with no obvious adhesion. Conclusion ＂A single medium-sized intramural fibroids, subserosal fibroids, laparoscopic myomectomy appears to be less bleeding,less postoperative morbidity, effective surgery,less surgicla trauma, faster postoperativ recovery, shorter length of hospitalization.