子宫肌瘤剔除术的术式变化及相关因素探讨

Investigation of the Changing Trend of Surgical Pathway of Myomectomy and Its Related Factors

目的：探讨子宫肌瘤剔除术的术式变化及相关因素。方法：回顾性分析我院近5年因患子宫肌瘤而行肌瘤剔除术（除外黏膜下肌瘤或子宫腺肌病患者）的421例患者临床资料，按术式不同分为3组，即阴式剔除术组、腹腔镜剔除术组及腹式剔除术组，比较3组的构成比、剔除肌瘤大小、手术时间、出血量等。结果：近5年来3组术式的总构成比依次为腹式剔除术组54．9％，阴式剔除术组为31．8％，腹腔镜剔除术组为13．3％；阴式剔除术组所占比例逐年显著上升，2007年达49．5％，首次超过腹式剔除术组34．1％；阴式剔除术组剔除的最大肌瘤平均直径显著低于腹式剔除术组（P〈0．01）；阴式剔除术组及腹腔镜剔除术组的术后排气时间及术后住院时间均低于腹式剔除术组（P〈0．05），而阴式剔除术组的手术时间及术中出血量又低于腹腔镜剔除术组（P〈0．05）。结论：只要适应证选择正确，目前3种子宫肌瘤剔除术式均是临床上安全有效可行的手术方式，其中阴式剔除术逐渐成为最受患者欢迎的主流术式之一。

Objective：To investigate the changing trend of surgiCal pathway of myomectomy and its relat- ed factors. Methods：The clinical data of 421 patients with fibroids had myomectomy （except submucous my- oma or adenomyoma） during the last five years were retrospectively analysed. The patients were divided into three groups according to the surgical pathway, namely VM （vaginal myomectomy） group and LM （laparo- scopic myomectomy） group and OM （open myomectomy） group. The constitutional percentage of each method in every year was compared and clinical features such as the size of tumor, operating time and blood loss were compared among the three groups. Results：The overall constitutional percentage of VM group and LM group and OM group during the last five years was 31.8% （134/421）, 13.3% （56/421）and 54.9% （231/421） respectively; However, the increasing rate of VM group was very remarkable and the percentage of VM group（49.5%） in 2007 was over that of the OM group（34.1%） firstly, The mean diameter of the maximal fibroid in VM group was significantly smaller than that in OM group（ P 〈0.01 ）, and the mean time of postoperative fabulence and hospital stay in VM group and LM group were significantly shorter than those in OM group（ P 〈 0.05）. The mean operating time and blood loss in VM group were significantly less than those in LM group（P〈0.05）. Conclusions：The three surgical pathways of myomectomy are all feasible , effec- tive and safe as long as their respective indications are selected carefully. The transvaginal myomectomy is （：lraduallv becoming one of the most common surgical modalitv of mvomectomv.