腹腔镜困难子宫肌瘤切除术82例临床分析

Complicated laparoscopic myomectomy:a clinical analysis of 82 cases

目的:探讨腹腔镜困难子宫肌瘤切除术的手术方法及临床价值。方法:2006年1月至2010年11月收治肥胖、粘连、阔韧带肌瘤、子宫前壁下段膀胱腹膜返折处肌瘤、子宫后壁下段近宫颈处肌瘤、巨大子宫肌瘤(直径≥10 cm)患者82例(观察组),将同期行开腹子宫肌瘤切除术的80例患者作为对照组。对比分析两组手术时间、术中出血量、手术并发症、肛门排气时间、术后发热、术后恢复情况。结果:观察组肿瘤直径≥10 cm的患者手术时间长于对照组(P<0.05),重度肥胖患者短于对照组(P<0.05);肌瘤直径<10 cm、重度肥胖和粘连患者术中出血量少于对照组(P<0.05),肌瘤直径≥10 cm者术中出血量多于对照组(P<0.05);其他指标两组差异无统计学意义(P>0.05)。结论:术者熟悉镜下解剖,仔细操作,技术娴熟,复杂的子宫肌瘤手术也可经腹腔镜顺利完成。

Objective：To explore the value and operative technique of complicated laparoscopic myomectomy. Methods：Eighty-two patients underwent complicated laparoscopic myomectomy from Jan. 2006 to Nov. 2010 were retrospectively analyzed. All 82 cases in the research group （RG） were fat, with abdominal adhesion, suffered from hysteromyoma at broad ligament, inferior part of anterior uter-ine wall urinary bladder peritoneum reflexion, posterior uterine wall near cervix or tumor diameter more than 10 cm. 80 patients who treated by open myomectomy during the same period were selected as the control group （CG）. The operative time, blood loss in the operation, operation complication, anus exhaust time, fever and postoperative recovery were compared between 2 groups. Results ： As for the diameter of myoma ≥ 10 cm,the operative time of the RG was longer than that of the CG （P 〈 0.05 ） while the operating time of obesity patients in the RG was shorter than that in the CG. The blood loss of patients with myoma diameter 〈 10 cm,obesity and adhesion was less than the CG （P 〈 0.05 ）,however,patients with myoma diameter≥ 10 cm was more than the CG （P 〈 0.05 ）. The other index of two groups were not significantly different（ P 〉 0.05 ）. Conclusions：On the basis of familiar anatomy, careful work and skilled tech-nique, laparoscopy is safe in treatment of complex hysteromyoma.