子宫肌瘤切除三种术式临床效果比较

Clinical comparison of three methods about the hysteromyomectomia

目的比较腹腔镜下子宫肌瘤切除术(laparoscopic hysteromyomectomia,LM)、经阴道子宫肌瘤切除术(transvaginal hysteromyomectomia,TVM)和开腹子宫肌瘤切除术(abdominal hysteromyomectomia,TAM)三种术式的临床效果。方法选择2006年7月至2007年7月入住天津市中心妇产科医院需手术治疗切除子宫肌瘤的150例患者,分为3组:LM组54例,TVM组46例,TAM组50例,对3组围手术期的手术时间、术中出血量、术后病率、术后住院天数等情况进行比较。结果3组手术时间、术中出血量、术后病率和术后住院天数差异均有统计学意义(P<0.05),TVM组手术时间、术中出血量和术后住院天数皆最短,TAM组术后病发生率高于TVM和LM组,差异均有统计学意义(P<0.05)。结论三种术式各有优劣,LM和TVM具有创伤小、术中出血少、术后恢复快、术后住院天数短等优点,但不能完全替代TAM,对于较困难的子宫肌瘤切除术,TAM仍为最佳选择。

Objective To compare the clinical effects on three methods of the hysteromyomectomia – Laparoscopic Hysteromyomectomia（LM）,transvaginal hysteromyomectomia（TVM） and Abdominal Hysteromyomectomia（TAM）. Methods 150 cases were divided into three groups as LM group with 54-inpatient,TVM group with 46-inpatient and TAM group with 50-inpatient. The data of operation time,the amount of bleeding,postoperative morbidity and days of postoperative hospitalization,etc. in three groups resulting from 150 inpatients in Tianjin central maternity hospital from July 2006 to July 2007 was analyzed and compared. Results There was significant difference of operation time,the amount of bleeding during operation,postoperative morbidity and days of postoperative hospitalization among three groups（P0.05）. The duration of operation,the amount of bleeding during operation and days of postoperative hospitalization of TVM group were the shortest. The postoperative morbidity of the TAM group was higher than those of the TVM and LM groups and the differences was statistical significance （P0.05）. Conclusion Every method had its own advantages and disadvantages. The advantages were smaller wound,less bleeding during operation,quicker recovery after operation and less days of postoperative hospitalization of LM and TVM methods but they could not completely replace TAM. For difficult hysteromyomectomia,the best choice did TAM.