腹腔镜辅助腹壁小切口与单纯腹腔镜子宫肌瘤切除术的对比研究

Comparative study between laparoscopic-assisted myomectomy with mini-incision at abdominal wall and laparoscopic myomectomy

目的:对比分析腹腔镜辅助腹壁小切口与单纯腹腔镜子宫肌瘤切除术的手术效果。方法:回顾分析2008年7月至2009年12月施行98例腹腔镜辅助腹壁小切口子宫肌瘤切除术(laparoscopic-assisted myomectomy,LAM)和95例腹腔镜子宫肌瘤切除术(laparoscopic myomectomy,LM)的临床资料,对比分析两种术式的手术效果及术后恢复情况。结果:LAM组手术时间明显短于LM组(t=25.37,P<0.01);术中平均出血量少于LM组(t=22.81,P<0.01);术后3 d平均体温、术后肛门排气时间、术中严重并发症及术后住院时间两组差异无统计学意义(P>0.05)。LAM组术中1例发生膀胱损伤;LM组1例术中损伤直肠1,例术后出现血肿。LAM组57例获得随访,腹部切口愈合好,无肌瘤复发;LM组63例获得随访,2例单个肌瘤复发。结论:LAM与LM是成熟的子宫肌瘤切除术,均具有患者创伤小、术后康复快等优点。LAM将镜下复杂的缝合操作简化,对瘤体较大、缝合较多的子宫肌瘤切除术有利,术中触摸可最大限度地发现肌瘤,降低肌瘤复发率。LM对术者操作技术有较高要求,术后腹壁更美观,肌瘤复发率较LAM高。

Objective： To compare the clinical value between laparoscopic-assisted myomectomy with mini-incision at abdominal wall and laparoscopic myomectomy. Methods：The clinical data of laparoscopic-assisted myomectomy with mini-incision at abdominal wall（LAM,n=98） and laparoscopic myomectomy（LM,n=95） from Jul.2008 to Dec.2009 were retrospectively analyzed,the therapeutic effects and the postoperative recovery were compared. Results：The operation time and the bleeding volume during operation were（75.21±12.75） min and（90.57±28.52） ml in LAM group,and（121.32±23.53） min,（130.83±35.13） ml in LM group,with significant differences between the two groups（P〈0.01）.No statistically significant difference was found between the LAM and LM groups in the average of postoperative body temperature for three days,the time of passage of gas by anus,intraoperative serious complications and postoperative hospital stay（P〈0.05）.The complications included 1 case of intraoperative injury of bladder in the LAM group,1 case of intraoperative rectal injury and 1 case of postoperative hematoma in the LM group.The rate of recurrence was 0 in the 57 follow-up cases of LAM group,while 2 in the 63 follow-up cases of LM group. Conclusions：Both LAM and LM are mature myomectomy operations with advantages such as less damage and faster recovery.LAM can simplify the complex suture under laparoscopy,especially for the large tumors.The first-hand touch can help to find hysteromyoma as far as possible,and cut down the rate of recurrence.LM requires operators to have good skills and could obtain better postoperative recovery at the abdominal wall,but the recurrence rate is higher than LAM.