小切口开腹与腹腔镜下巨大子宫肌瘤剔除术临床结局分析

Clinical Outcome of Gigantic Hysteromyoma Myomectomy by Laproscopy and Minilaparotomy

目的评价小切口开腹与腹腔镜下巨大子宫肌瘤剔除术的优缺点和手术适应证。方法回顾分析2009年6月至2011年5月本院妇科收治的直径8～12 cm子宫肌瘤患者的临床资料,比较同期30例小切口及38例腹腔镜下子宫肌瘤切除术的手术效果和术后康复情况。结果两组手术均顺利完成,没有延长切口或中转开放。手术时间开腹组显著短于腹腔镜组[(63.55±21.95)min vs(91.33±36.55)min],差异有统计学意义(P<0.01),术中出血量两组无统计学差异[(122±84.75)ml vs(148.9±211.2)ml],术后镇痛药使用率开腹组显著高于腹腔镜组(50.0%vs 13.3%)(P<0.01),术后平均肛门排气时间两组间无显著性差异[(25.87±8.47)h vs(25.92±7.38)h](P>0.05),术后病率两组间无显著性差异(P>0.05)。结论巨大子宫肌瘤小切口开腹及腹腔镜下剔除术均为微创术式,两种术式均安全可靠;腹腔镜手术需要医师有丰富的腹腔镜手术经验及缝合技术,手术时间延长;合并肌壁间多个肌瘤时开腹手术更具优势。

Objective To analyze the feasibility and safety of laparoscopic myomectomy and mimilaparotomy in patients with large hysteromyoma. Methods 30 hysteromyoma paticntstreated by laproscopic myomectomy and 38 hysteromyoma patients treated by open mimilaparotomy during the same period were analyzed respectively by tumor size, operation effect and recovery effect. The size of hysteromyoma ranged from 8 to 12 cm. Results The processes of all operations were successful without any complication. The mean operating time in the laproscopic myomectomy group was longer than that in the group with small incision （p 〈 0.01）. There was no significant difference in blood loss between two groups （p 〉 0.05）. The postoperative analgesic usage was higher in laparotomy group. The mean recovery time of bowel function and postoperative morbidity were no significant difference （p 〉 0.05）. Conclusion Both small incision myomectomy and lapamscopic myomectomy are micro-invasive operations, lapamscopic myomectomy is associated with less postoperative pain and longer operative time and operators should be skillful during operating lapamscopy and the suturing. For with the treatment of multiple uterine fibroids, the minilaparotomy surgery is better.