阴式子宫肌瘤剔除术409例临床分析

Clinical Analysis of 409 Cases Treated with Transvaginal Myomectomy Surgery

目的:探讨经阴道子宫肌瘤剔除术的安全性与可行性。方法:对409例要求保留子宫的子宫肌瘤患者,行阴式子宫肌瘤剔除术。患者术前检查肌瘤平均2.3个,直径平均4.8cm,子宫平均10.8孕周大,平均年龄36.9岁。结果:409例患者均成功实施手术,手术成功率100%。剔除肌瘤平均2.6个,平均重102.6g,平均手术时间30.5min,平均出血量120.5ml,术后肠道功能恢复平均1.2d,留置尿管平均16h,阴道流液4.1d,体温恢复正常时间1.5d。术后病率2.5%,术后住院时间平均5.1d。多个肌瘤剔除的手术时间和手术出血量比单个肌瘤多(P<0.05);>12孕周的子宫剔除肌瘤时所需手术时间和手术出血量比<12孕周的子宫多(P<0.05);肌瘤位置在肌壁间时剔除的手术时间和手术出血量比浆膜下多(P<0.05)。结论:严格掌握手术适应证及熟练的阴式手术技巧,经阴道剔除子宫肌瘤是安全可行的。

Objective ：To explore the feasibility and safety of vaginal myomectomy.Method ：409 patients who ask to preserve uterine had been operated on for uterine fibroids. The average number of fibroids of every patient was 2.3.The average diameter of fibroids was 4.8 cm.The average size of uterus was 10.8 gestational age.The average age of the patients was 36.9 years.Result ：The 409 surgery patients were successful. The success rate of operation was 100%.The average 2.6 fibroids were removed. The average weight of fibroids was 102.6 g.The average operation time was 30.5 min.The average blood loss was 120.5 ml.Intestinal function average recovery time after operation was 1.2 d.The average time of catheterization was 16 hours.The time of vaginal fluid was 4.1 d.The time for body temperature returned to normal after operation was 1.5 d.Incidence rate after operation was 2.5%.The average hospital stay time after operation was 5.1 d. Operation time and amount of blood loss surgery of multiple fibroids were more than a single fibroids （P〈0.05）; 〉 12 pregnant uterine fibroids eliminate the week for operation time and amount of blood loss surgery were more than〈12 gestational age at womb （P〈0.05）; Fibroids position in the intramural when the operation time and eliminate the bleeding surgery were more than subserosal （P〈0.05）. Conclusion ：Vaginal myomectomy is safe and feasible procedure with strict control of surgical indication and skilled vaginal surgical techniques.