腹腔镜与开腹子宫肌瘤剔除术的比较

Comparison between Laparoscopy and Open Surgery for Meyomectomy

目的探讨腹腔镜下子宫肌瘤剔除术的临床价值。方法回顾性分析我院2008年1月～2011年1月腹腔镜子宫肌瘤剔除术135例(腹腔镜组)和开腹子宫肌瘤剔除术132例(开腹组)的临床资料。对2组手术时间、术中出血量、胃肠功能恢复情况、住院时间、镇痛药使用、术后病率、术后妊娠率等情况进行比较。结果与开腹组相比,腹腔镜组术中出血量少[(42.2±38.5)ml vs.(75.2±34.3)ml,t=-7.389,P=0.000],胃肠功能恢复时间短(以有肛门排气为准)[(15.9±3.5)h vs.(42.2±5.2)h,t=-48.580,P=0.000],术后住院时间短[(4.6±1.2)d vs.(7.1±1.2)d,t=-17.020,P=0.000],镇痛剂使用率低[0 vs.52.3%(69/132),P=0.000],术后病率低[0 vs.13.6%(18/132),P=0.000],但手术时间长[(95.8±30.2)min vs.(71.2±32.1)min,t=6.451,P=0.000]。2组术后妊娠率无显著性差异[51.1%(23/45)vs.52.4%(22/42),χ2=0.014,P=0.906],2组术后妊娠患者均未发生妊娠中子宫破裂。结论腹腔镜下子宫肌瘤剔除术是子宫肌瘤保留子宫手术治疗的理想术式。

Objective To explore the clinical value of laparoscopic myomectomy.Methods We retrospectively analyzed the clinical data of 135 cases of laparoscopic myomectomy（laparoscopy group） and 132 cases of transabdominal myomectomy（open group）,which we performed in this hospital from January 2008 to January 2011.The operation time,intraoperative blood loss,recovery time of gastrointestinal function,hospital stay,postoperative analgesic use,postoperative morbidity,and the rate of pregnancy were compared between the groups.Results Compared to the open group,laparoscopy group had significantly less intraoperative blood loss [（42.2±38.5） ml vs.（75.2±34.3） ml,t=-7.389,P=0.000],shorter recovery time of gastrointestinal function [（15.9±3.5） h vs.（42.2±5.2） h,t=-48.580,P=0.000],shorter hospital stay [（4.6±1.2） d vs.（7.1±1.2） d,t=-17.020,P=0.000],less analgesic use [0 vs.52.3%（69/132）,P=0.000],lower postoperative morbidity [0 vs.13.6%（18/132）,P=0.000],but longer operation time [（95.8±30.2） min vs.（71.2±32.1） min,t=6.451,P=0.000].No significant difference existed between the two groups in postoperative pregnancy rate [51.1%（23/45） vs.52.4%（22/42）,χ2=0.014,P=0.906].No uterine rupture occurred during pregnancy.Conclusion Laparoscopic myomectomy is an ideal operation method,by which the uterus can be retained.