腹腔镜下假包膜内子宫肌瘤剔除术患者的预后和生育结局

Prognosis and reproductive outcome of laparoscopic intracapsular myomectomy

目的通过回顾性研究来评价腹腔镜下假包膜内子宫肌瘤剔除术的预后和生育结局。方法 2007年3月~2012年3月,673例浆膜下和肌壁间肌瘤患者接受了腹腔镜下假包膜内子宫肌瘤剔除术,观察指标为术后合并症,症状缓解,需要再次手术及生育结局。结果浆膜下肌瘤占42.4%,肌壁间肌瘤占57.6%,平均手术时间是96±41 min,平均失血量是128±46.2 ml,82.3%的患者在术后48 h出院,无近期并发症。2.3%的患者因肌瘤复发而接受了二次腹腔镜下子宫肌瘤剔除术。有生育要求的297例患者中71%最终成功妊娠,剖宫产率为49.8%,阴道助产分娩8%,自然分娩率为42.2%,无子宫破裂。结论腹腔镜下假包膜内子宫肌瘤剔除术保留了纤维假包膜,通过保留子宫肌层的完整性而增强了愈合,没有近期手术并发症,有较好的妊娠率和分娩结局。

Objective To assess the prognosis and reproductive outcomes of laparoscopic intracapsular myomectomy.Methods A total of 673 women received subserosal and intramural intracapsular laparoscopic myomectomy between March,2007 and March,2012,and their post-operative complications,the need for subsequent surgery,symptomatic relief and reproductive outcomes were analyzed.Results Of these patients,42.4% had subserosal myomas and 57.6% had intramural myomas.The mean total operative time was 96±41 min with a mean blood loss of 128±46.2 ml,and 82.3% of the patients were discharged 48 h after the operation without early complications.A small fraction(2.3%) of the patients had a second laparoscopic myomectomy for recurrent fibroids.Of the fertility-demanding women who underwent myomectomy,71% achieved pregnancy,49.8% underwent caesarean section,8% had operative vaginal deliveries,and 42.2% had spontaneous deliveries;uterine rupture occurred in none of the cases.Conclusions Laparoscopic intracapsular myomectomy,by preserving the fibroid pseudocapsule and myometrial integrity,has no early postoperative complications and ensures good fertility rates and reproductive outcomes.