腹腔镜子宫肌瘤剔除术中转开腹的有关因素分析

Risk Factors for Conversion to Laparotomy during Laparoscopic Myomectomy

目的探讨腹腔镜子宫肌瘤剔除术(laparoscopic myomectomy,LM)中转开腹的有关因素。方法对我院2006年1月至～2011年11月595例接受LM患者的临床资料进行回顾性分析。结果 LM中转开腹率为4.7%(28/595)。宫颈肌瘤及阔韧带肌瘤的中转开腹率明显高于子宫体部肌瘤(χ2=13.732,P=0.000;χ2=10.298,P=0.000),直径≥8 cm肌瘤的中转开腹率显著高于直径<8 cm肌瘤(P=0.029),单发肌瘤和多发肌瘤的患者中转开腹率无显著性差异(χ2=0.000,P=1.000)。LM中转开腹原因:肌瘤位置特殊致操作困难13例(46.4%),术中大出血8例(28.6%),严重盆腹腔粘连5例(17.9%),恶性肿瘤2例(7.1%)。结论子宫肌瘤位置特殊是LM转开腹的主要原因,不断提高腹腔镜手术技术,术前充分评估病情,严格掌握腹腔镜手术指征,可降低子宫肌瘤剔除术的中转开腹率。

Objective To investigate the risk factors for converting to open surgery during laparoscopic myomectomy（LM）.Methods From January 2006 to November 2011,totally 595 patients underwent LM in our hospital.We retrospectively analyzed their clinical records.Results The total conversion rate to laparotomy was 4.7%（28/595）.The conversion rate in cervical myoma and the myoma of the broad ligament were significantly higher than that in the myoma of the uterine body（χ2=13.732,P=0.000;and χ2=10.298,P=0.000,respectively）;in giant hysteromyoma（≥8 cm in diameter）,the rate was significantly higher than that in small hysteromyoma（8 cm,P=0.029）.No remarkable difference existed in the conversion rate between multiple and single myoma（χ2=0.000,P=1.000）.The risk factors of conversion included unusual location of hysteromyoma（46.4%,13/28）,bleeding（28.6%,8/28）,severe pelvic adhesion（17.9%,5/28）,and malignant tumor（7.1%,2/28）.Conclusions The main factor for conversion to laparotomy during LM is unusual location of hysteromyoma.Comprehensive preoperative evaluation of patients＇ condition and restrict indications for the procedure are essential to reduce the rate of conversion.