腹腔镜下子宫肌瘤原位粉碎并核除术的临床分析

The clinical analysis of uterine fibroids removed and in situ morcellation in laparoscopic

目的评估在腹腔镜下子宫肌瘤核除并在原位进行粉碎的结局。方法对2009年3月～2010年3月82例诊断为子宫肌瘤或子宫肌腺病的患者进行登记。根据子宫肌瘤的重量将患者分为3组,A组:子宫肌瘤<150g,B组:肌瘤150～349g,C组:肌瘤>349g,对3组子宫肌瘤重量、手术时间、失血情况、住院时间及并发症进行分析。结果 A、B、C3组的子宫肌瘤平均重量分别为(73±43)、(214±52)、(571±218)g,手术的时间分别为(79±17)、(84±22)、(121±32)min。82例患者子宫肌瘤的平均重量(265±240)g,手术的平均时间(93±30)min。手术时间随肌瘤的重量增加而延长。在C组中有2例(8%)患者失血过多,1例需要输血,但是没有转为开腹手术的记录。结论通过对腹腔镜子宫肌瘤切除术的手术技巧和器械的改进,达到了缩短手术时间、减少术中出血的目的,即使较大径线的子宫肌瘤也能达到较好的临床效果。

Objective To evaluate the results of myoma enucleation by situ morcellation in laparoscopic myomectomy. Methods A total of 82 patients diagnosed with myoma or adenomyosis from March 2009 to March 2010 were enrolled. The patients were divided into three groups according to the myoma weight, group A with myomas less than 150 g; group B with myomas150-349 g, and group C with myomas greater than 349 g. The operative time, myoma weight, blood loss, duration of hospital stay, and complication experienced were recorded for analysis. Results The mean myoma weights were （73±34） g, （214±52） g, and （571±218） g for groups A, B, and C, respectively; the mean operative times were （79±17） minutes, （84±22） minutes, and （121±32） minutes, respectively. The mean myoma weight was （265± 240） g and the mean operative time was （93 ±30） minutes in 82 cases. The operative time increased with myoma weight. Two cases （8%） in group C had excessive intraoperative hemorrhage and one case required a blood transfusion. There was no conversion to laparotomy. Conclusion Through the improvement of operation techniques and instruments for laparoscopic myomectomy, can reach to shorten operation time, reduce intraoperative hemorrhage, even larger diameter of myoma of uterus can achieve good clinical results.