子宫肌瘤三种手术方式的效果分析

The clinical comparision of the effect of the three operative treatment for hysteromyoma

目的:比较腹腔镜下子宫肌瘤剔除术(laparoscopic myomectomy,LM)、子宫动脉栓塞术(utreine artery embolization,UAE)、高强度聚焦超声(high intensity focused ultrasound,HIFU)三种方式治疗宫肌瘤的临床疗效。方法:回顾性分析2009年1月—2011年1月在我院行腹腔镜下行子宫肌瘤剔除术患者60例、子宫动脉栓塞术患者11例、高强度聚焦超声治疗术患者47例的临床资料。术后随访12月,评价临床疗效。结果:LM组手术时间、术中出血量均高于UAE组及HIFU组,HIFU组术后住院天数明显少于LM组及UAE组,差异有统计学意义;有效率:术后随访12月,LA组肌瘤术后瘤体全部消失,45例临床症状明显改善,15例症状部分改善,总有效率达100%;UAE组1例术后瘤体无明显缩小,总有效率为91%;HIFU组3例瘤体缩小不明显,1例临床症状加重,改行其他方式治疗,总有效率为92%。3组间总有效率比较差异无显著性意义(P>0.05),治愈率比较有统计学意义(P<0.05),以LM组最高。全部病例均无严重并发症及重要脏器损伤。结论:三种方式均能有效的治疗子宫肌瘤。LM组术后临床症状迅速改善,但此术式需要良好的手术技巧;UAE及HIFU两种方式创伤更小,但肌瘤缩小及症状缓解需较长时间。三种方式各有其特点及适应症,选择治疗方式前应综合评估。

Objective： To disscuss the characteristics of treatments for hysteromyoma , the efficacy of laparoscopic myomectomy （LM）, utreine artery embolization （UAE） and high intensity focused ultrasound （HIFU） were observed in this study. Method： Retrospective analyzing 118 hysteromyoma cases, who came into our hospital and demanded their uterine retained between 2009.1 and 2011.1 ;6o cases in the LM group, 11 cases in the UAE greup,47 cases in the HIFU group,respetively; observing the condition of the three groups during the perioperative period; comparing the surgical results and the post- operation recovery;follow- up twelve mouths after operation before evaluating the curative effect. Results：the time and the amount of bleeding within the operation , LM group is higher than both of the UAE and HIFU group, the differences between the three groups are significant（ P 〈 0. 05）; effetive rate：the neoplasma disappears totally in the LA group after operation- 45 cases＇ clinical symptoms have got obvious improvement; 15 cases＇ symptoms have got partial improvement, the wholepossibility ot effectiveness amounts to a hundred percent;2 cases myoma didnot shrink alter operation in the UAE group, and the effective rate is 81 percent three cases myoma didnot reduce conspicuously , clinical symptoms have not got obvious improvement, then other surgical methods were added, effective rate is 92 percent The whole possibility of effectiveness of three groups are no significant difference . There were significant difference in the cure rate （P 〈 0.05 ）, and the cure rate of LM group is the most. The reducing volume of hysteromyoma and resission in UAE group and LM group need more time. there are not any severe complications _and vital organs injurry in the three group_s. Conclusion： Three kinds of treatment is effective in the treatment of urer/ne fibroids. LM group ofpostoperative clinical symptoms ciuickly improved but the operatinon need good surgical skills; UAE and HIFU two ways have less wounds, but reducing symptoms needsa long time. Three ways each has its characteristics and indications, choose before treatment should be comprehensive evaluation.