腹腔镜辅助与腹式肌瘤剔除术治疗子宫肌瘤临床比较

Clinical comparison of laparoscopic-assisted and abdominal myomectomy in treatment of hysteromyoma

目的观察腹腔镜辅助与腹式肌瘤剔除术治疗子宫肌瘤的临床效果。方法 148例子宫肌瘤患者,完全随机分为腹腔镜组(75例)和腹式组(73例),腹腔镜组给予腹腔镜辅助肌瘤剔除术,腹式组给予腹式肌瘤剔除术,术后均随诊6个月。观察患者手术时间及术中出血量、单个肌瘤剔除时间、肠功能恢复时间、术后住院时间及术后感染率。结果腹腔镜组手术时间47～124min,出血量84～301mL;腹式组手术时间60～187min,出血量112～413mL,腹腔镜组出血量明显小于腹式组(P<0.05)。单个肌瘤剔除时间,腹腔镜组明显长于腹式组(P<0.05)。腹腔镜组术后住院2～5d,肠功能恢复时间7～23h,术后感染2例(2.67%);腹式组术后住院3～10d,肠功能恢复21～56h,术后感染11例(15.07%)。腹腔镜组住院时间及肠功能恢复时间均明显短于腹式组(P<0.05),术后感染率也明显低于腹式组(P<0.05)。术后随诊6个月,所有患者B超检查肌瘤无复发、无明显肌瘤结节。结论腹腔镜辅助肌瘤剔除术相较于腹式肌瘤剔除术具有术中出血量少,创伤小,住院时间短,术后肠功能恢复快,感染少的特点,是一种值得推广的微创手术。

[Objective ] To compare laparoscopic-assisted and abdominal myomectomy in treatment of hys- teromyoma. [Methods] 148 cases diagnosed as hysteromyoma were divided into two groups randomly. The laparo- scopie-assisted myomeetomy （LAnai） group were given laparoscopie-assisted m）,omectomy, while the abdominal my- oectomy （AM） group were given abdominal myomectomy. The operation duration, intraoperative blood loss, removal time of single myoma, postoperative infection rate, postoperative intestinal recovery and hospitalization time were compared between the two groups. [ Results ] At the aspect of intraoperative blood loss, postoperative infection rate, postoperative intestinal recovery and hospitalization time, AM group was significantly better than AM group （P 〈 0.05）, however AM group＇s removal time of single myoma was significantly shorter than LAM group （P 〈0.05）. All cases were followed up for 6 months, none of them recurred. [ Conclusion] Compared with abdominal myomectomy, laparoscopic-assisted myomectomy is a minimally invasive surgery with significant advantage of less intraoperative blood loss,trauma,shorter postoperative intestinal recovery and hospitalization time and lower postoperative infection rate. It＇s worthy to be promoted.