经阴道与腹腔镜下子宫肌瘤剔除术的对照研究

Comparison of Transvaginal and Laparoscopic Myomectomies

目的探讨经阴道与腹腔镜下子宫肌瘤剔除术的疗效及临床应用价值。方法回顾分析2007年3月～2008年10月58例经阴道子宫肌瘤剔除术(阴道组)和55例腹腔镜下子宫肌瘤剔除术(腹腔镜组)的临床资料,对2组患者的手术时间、术中出血量、剔除肌瘤重量、术后病率、肛门排气时间、住院时间、住院费用等进行对照分析。结果 2组术后肛门排气时间、住院时间均无统计学差异(P=0.056,P=0.067),但经阴道组手术时间(62±13)min显著短于腹腔镜组(97±18)min(t=-11.895,P=0.000),术中出血量(105±30)ml显著少于腹腔镜组(180±25)ml(t=-14.396,P=0.000),术后病率(48.3%)显著高于腹腔镜组(23.6%)(χ2=7.410,P=0.006),住院费用(5216.4±28.5)元显著低于腹腔镜组(7421.6±31.2)元(t=-392.597,P=0.000)。结论 2种术式各有适应证而不可完全互相替代,但从卫生经济学角度而言,经阴道手术可作为治疗的首选术式,并值得在临床推广应用。

Objective To compare the efficacy and clinical value of transvaginal myomectomy and laparoscopic myomectomy.Methods The clinical data of 58 cases of transvaginal myomectomy（transvaginal group）and 55 cases of laparoscopic myomectomy（laparoscopic group）were retrospectively analyzed in this study.The operation time,blood loss,amount and weight of resected myomas,postoperative recovery time of gastrointestinal function,and hospital stay and cost were compared between the two groups.Results No significant difference was detected in the recovery time of gastrointestinal function and length of hospital stay between the two groups（P=0.056,P=0.067）.Whereas,transvaginal group showed significantly shorter operation time [（62±13）min vs（97±18）min;t=-11.895,P=0.000],less blood loss [（105±30）ml vs（180±25）ml;t=-14.396,P=0.000],lower postoperative morbidity [48.3% vs 23.6%,χ2=7.410,P=0.006],and less hospital cost [（5216.4±28.5）RMB vs（7421.6±31.2）RMB,t=-392.597,P=0.000].Conclusions Laparoscopic myomectomy can not be totally replaced by transvaginal myomectomy because the indications for the two procedures are different,however,transvaginal myomectomy can be the first choice for patients with uterine leiomyoma.