腹腔镜下子宫肌瘤切除术中3种止血方法的对比分析

Contrastive study on the hemostasis of several methods in myomectomy under laparoscopy

目的:探讨腹腔镜下子宫肌瘤切除术中分别用垂体后叶素、缩宫素及子宫动脉阻断止血的优缺点。方法:回顾分析我院2008年1月～2010年6月90例腹腔镜下子宫肌瘤切除术患者的临床资料,90例患者随机分为3组,每组30例,垂体后叶素止血组,于切开浆膜层前子宫肌层注射垂体后叶素6IU;缩宫素止血组,注射缩宫素20U;子宫动脉阻断止血组,双侧子宫动脉上行支阻断后行肌瘤切除术,比较3组手术时间、术中出血量及术后血肿形成。结果:垂体后叶素止血组平均手术时间为(83.7±29.5)min,与子宫动脉阻断止血组[(93.5±32.2)min]相近,缩宫素止血组平均手术时间为(115.30±62.50)min,明显长于前两组(P<0.05);子宫动脉阻断止血组、垂体后叶素止血组术中出血分别为(70.2±34.6)、(78.5±35.2)mL,明显少于缩宫素止血组[(150.3±50.5)mL](P<0.05);子宫动脉阻断止血组及垂体后叶素止血组术后无1例血肿形成,缩宫素止血组有1例血肿形成。结论:腹腔镜下子宫肌瘤切除术中使用垂体后叶素止血及子宫动脉阻断术止血的止血效果均优于缩宫素,是有效的止血方法。垂体后叶素止血操作易于掌握,而子宫动脉阻断术则相对复杂,要求术者必须具有熟练的腹腔镜操作技术。

Objective： To explore the effects of hemostasis with oxytocin 、pituitrin or Uterine artery occlusion in myomectomy under laparoscopy.Methods： The clinical data of 90 cases performed myomectomy under laparoscopy from Jan.2008 to May.2010.30cases were pituitrin group,30 cases were oxytocin group.30 cases were Uterine artery occlusion group.Before open uterine incision,the cases of pituitrin group were injected with 6IU pituitrin oxytocin group injected 20μ oxytocin.Uterine artery occlusion group were treated scending branch of bilateral uterine artery occlusion.The mean operative time,the mean hemorrhage volume during the operation and uterine hematoma formation were analyzed.Results： The mean operative time of the pituitrin group was（83.7±29.5） min,similar to the Uterine artery occlusion group（93.5±32.2） min.The operative time was（115.30±62.50）min in oxytocin group.significantly longer than the other two groups（P0.05）.Blood loss volume during operation was（70.20±34.60）ml in the Uterine artery occlusion group;（78.5±35.2） ml in pituitrin group,significantly less than the oxytocin group（150.3±50.5） ml（P0.05）;no postoperative hematoma formation was found in the uterine artery occlusion group and the pituitrin group,1 cases in the oxytocin group.Conclusions：The effect of hemostasis with pituitrin in-myomectomy under laparoscope is better than oxytocin group.The method of hemostasis with pituitrin is easy to perform operation,The method of hemostasis with Uterine artery occlusion is more skill and complicate.