腹腔镜联合手指触诊法剔除多发性子宫肌瘤的随机对照研究

A randomized control investigation in laparoscopic myomectomy combined finger-assisted method for multiple myomas

目的与小切口子宫肌瘤剔除术进行随机对照研究,评价腹腔镜手术联合手指触诊法在子宫多发性肌瘤中的临床意义。方法 100例需手术的有症状子宫肌瘤患者随机分成腹腔镜肌瘤剔除组(辅以手指触诊)及小切口开腹肌瘤剔除组。比较两组术中出血、手术时间、术后肛门排气时间、术后24hVAS评分、剔除肌瘤个数、住院时间、术后发热及术后复发的差异。结果术中出血、手术时间、剔除肌瘤个数、术后发热、术后复发两组差异无显著性(P>0.05),腹腔镜组术后肛门排气时间、住院时间显著短于小切口开腹肌瘤剔除组(P<0.01),术后24hVAS评分亦显著低于小切口开腹组(P<0.01)。结论手指触诊法弥补了腹腔镜剔除肌瘤不能直观感觉的缺点,减少小肌瘤的残留,降低复发率,通过准确定位缩短手术时间,减少出血。腹腔镜联合手指触诊法多发性子宫肌瘤剔除术具有疼痛轻、恢复快、住院时间短等优点,适合具备熟练缝合技巧的单位推广。

[Objectives] This RCT aimed at comparing short-term outcomes of patients who underwent finger-assisted laparoscopic myomectomy for multiple myomas and mini-laparotomy. To evaluate the efficacy and feasibility of finger-assisted laparoscopic myomectomy for multiple myomas. [Methods] A total of 100 patients with symptomatic uterine myomas requiring myomectomy were randomly allocated to the finger-assisted laparoscopy group or the mini-laparotomy group. Laparoscopic myomectomy technique was modified, that was insertion of two fingers into the vagina to elevate the uterus, while one finger of the other hand were inserted into the abdomen through a suprapubic 15 mm trocar port for palpation of small myomas, which did not distort the uterine contour. Main outcome measures were blood loss, operating time, number of leiomyomas, time to flatus, postoperative VAS, postoperative fever, postoperative hospital stay and recurrence. [Results] No significant differences were noted between finger-assisted laparoscopy group and mini-laparotomy group for hospital stay blood loss, operating time, number of leiomyomas, postoperative fever, postoperative hospital stay and recurrence （P 0.05）. There were significant differences for time to flatus, postoperative VAS, and postoperative hospital stay （P 0.01）. [Conclusions] Finger-assisted laparoscopic myomectomy appears to provide better outcomes when compared with laparotomy. Finger-assisted laparoscopic myomectomy is a feasible and safe approach in the surgical treatment of multiple myomas.