垂体后叶素和缩宫素在大型内突壁间子宫肌瘤腹腔镜剔除术中的应用

Comparison of pituitrin and oxytocin for hemostasis during laparoscoplc resection of intramural hysteromyoma

目的观察大型内突壁间子宫肌瘤腹腔镜剔除术应用垂体后叶素及缩宫素止血的疗效对比。方法 2010年1月～2012年6月对110例大型内突壁间子宫肌瘤施行腹腔镜子宫肌瘤剔除术;其中垂体后叶素组58例,切开浆膜层前子宫肌层注射垂体后叶素6IU+0.9%氯化钠注射液10mL;缩宫索组52例,注射缩宫素20IU+0.9%氯化钠注射液10mL。对两组手术时间、术中出血量、术后血红蛋白及用药前后血压的变化进行比较。结果两组手术均顺利完成,无中转开腹病例。垂体后叶素组手术时间(68.9±10.8)min与缩宫素组(88.2±17.6)min相比,明显减少(t=-3.538,P=0.021),术中出血量(65.8±16.9)mLvs(88.4±26.5)mL也明显减少(t=-3.153,P=0.033),术后血红蛋白下降幅度小[(10.1±2.9)g/Lvs(15.2±2.2)g/L,t=-4.223,P=0.012]。术中用药后15min,垂体后叶素组收缩压上升(156.2±5.8)mmHg,显著高于缩宫素组[(135.6±12.0)mmHg,t=3.289,P=0.039],用药30min和45min后,垂体后叶素组与缩宫素组收缩压无显著性差异(P>0.05)。结论大型内突壁间子宫肌瘤腹腔镜剔除术中使用垂体后叶素止血效果优于缩宫素,可明显减少术中出血,减少手术时间,值得推广应用。

Objective To compare the hemostasis effect of pituitrin and oxytocin in laparoscopic surgery for intramural hysteromyoma. Methods Clinical data of 110 cases with intramural hysteromyoma who underwent laparoscopie resection from January 2010 to June 2012, were enrolled into this study（58 cases in pituitrin group, 52 cases in oxytocin group）.Before open placenta incision, the eases in pituitrin group were injected with pituitrin 6 IU±nornlal saline 10 mL and oxytoein group recieved 20 IU oxytocin±normal saline 10 mL.The blood pressure,operation time, blood loss during the operation and the postoperative change of hemoglobin were analyzed. Results All the operations were successfully completed without converting to transabdominal operation.The operation time of the pituitrin group were significantly shorter than that in the oxytocin group[（68.9 ± 10.8）min vs （88.2 ± 17.6）min, t= -3.538, P=0.021].The blood loss of the pituitrin group were significantly less than that of oxytocin group[（65.8 ± 16.9） ml vs.（88.4 ± 26.5）mL, t=-3.153, P=0.033].The decrease of hemoglobin after operation in pituitrin roup were smaller than that of oxytoein group[（10.1 ± 2.9）g/L vs （15.2 ± 2.2）g/L, t=-4.223, P=0.012].The blood pressureincreased 15 min after pituitrin injection in the pituitrin group to（156.2 ± 5.8）ram Hg, which was significantly higher than that of oxytocin group[（135.6 ± 12.0）mm Hg, t=3.289, P=0.039].No significant differences in blood pressure increase in 30 and 45 min after injection were observed between the two groups（P 〉 0.05）. Conclusion The effect of hemostasis with pituitrin in laparoscopy for intramural hysteromyoma is better than oxytoein.Injection of pituitrin can decrease intraoperative blood loss and shorten operation time.