大型内突壁间肌瘤手术方法选择的临床探讨

The Operation Method of Large Intramural Myoma with a Little Part of the Myoma in the Uterine Cavity

[目的]探讨临床治疗肌瘤直径大于5cm的大型内突壁间肌瘤的手术方法。[方法]回顾性分析本院2006年1月至2010年12月之间121例因月经过多住院的大于5cm的内突壁间肌瘤的病历资料,按手术方法分为A组(n=36):采用宫腔电切镜下子宫肌瘤切除术(TCRM)手术治疗,B组(n=85):采用腹腔镜手术子宫肌瘤切除术(LM)。观察手术时间,术中出血量,术中术后并发症和随访患者满意度。[结果]A组中19例需再次手术(设为A2组),再次手术顺利,未发生水中毒。17例一次性切除的病例中发生1例水中毒,1例出血超过500mL。B组13例子宫内膜切穿,术后发生3例腹壁切口子宫内膜异位结节,发生腹壁切口疝1例,发生皮下气肿6例,大面积皮下出血3例,并发症两组比较,差异有统计学意义(P<0.05)。手术时间、术中出血量B组与A组、A2与A组比较,差异均有统计学意义(P<0.05);术后随访A组满意率为94.44%,11例获得正常分娩。B组满意率为75.29%,11例获得正常分娩。[结论]对于治疗大型内突壁间肌瘤,TCRM在出血、并发症、患者满意度等方面较LM更有优势,对妊娠和分娩更有利。

[Objective] To study the clinical operation method of intramural myoma,which is over 5cm and a tittle part of the myoma in the uterine cavity accompanies with menorrhagia. [Methods] A retrospective analysis of 121 patients with intramural myoma,with over 5cm and a little part of the myoma in the uterine cavity with menorrhagia in the last 5 years in our hospital was conducted. According to operation method, 121 cases were divided into group A：36 cases of transcervical resection of myoma（TCRM）, group B：85 cases of laparoscopic myomectomy（LM）, and observation of the operation time, the intra-operative blood loss, complications and postoperative follow-up about patient＇s satisfaction. [Results] 19 cases （named A2）were needed second operation in 36 cases of TCRM, and the second operation was very smooth with the left myoma removed completely, and no water poisoning in all of 19 cases. One case of water poisoning and one case of blood loss over 500mL in 17 cases, whose myoma was removed completely at first operation. 13 cases of endometium perforation and following 3 cases got abdominal incision endometriosis knot, 8 blood loss over 500mL, 1 blood loss over 2000mL after operation, 6 gas swollen under skin, 3 bleeding under large area skin in 85 cases of LM. Compare two group complications, statistics existed significantly differences. Operation time, group B： 79.76±17.19min, group A： 69.31±14.98min, group A2： 112.11±33.43min,compare group B with group A and group A2, with statistically significant differences. Intra-operative blood loss, group B： 100.06 ± 93.65mL, group A： 61.53 ± 45.08mL, group A2： 26.32 ± 14.61mL, compare group B with group A and group A2, with statistically significant differences. Postoperative follow-up, 34 cases satisfaction of TCRM, satisfied with the rate of 94.44%, 13 cases pregnancy, with 11 cases normal delivery. 64 cases satisfaction of LM, satisfied with the rate of 75.29%, 15 cases pregnancy, 11 cases normal delivery. Compare two groups, statistically significant differences. [ Conclusions ] To treat large intramural myoma with a little part of the myoma in the uterine cavity are feasible, TCRM has advantage in bleeding,complications, patients satisfaction,and more favourable for pregnancy and defivery.