悬吊式无气腹腹腔镜与气腹腹腔镜在子宫肌瘤切除术中的多中心、随机对照研究

Multicentre,randomized clinical trial of gasless versus conventional laparoscopy in uterine myomectomy

目的:比较悬吊式无气腹腹腔镜与气腹腹腔镜在子宫肌瘤切除术中的可行性、安全性及手术效果。方法:将3家医院收治的474例子宫肌瘤患者随机分为2组,分别采用悬吊式无气腹腹腔镜(239例)和传统气腹腹腔镜(235例)行子宫肌瘤切除术。比较2组患者的手术时间、术中出血量、术中切除肌瘤数、术后腹腔引流量、术后体温持续时间、肛门排气时间等情况。结果:两种手术方式均能完成子宫肌瘤的切除。悬吊式腹腔镜组和气腹腹腔镜组的平均手术时间分别为(65.5±12.5)min和(100.0±10.5)min,剥除肌瘤数目分别为(6.0±1.4)个和(2.2±1.3)个,术中失血量分别为(110.5±30.5)ml和(250.4±35.3)ml,术后腹腔引流量分别为(120.5±23.0)ml和(260.2±31.5)ml,均差异显著(P<0.01);而术后体温持续时间、肛门排气时间和平均住院时间均无显著差异(P>0.05)。结论:悬吊式无气腹腹腔镜与气腹腹腔镜均能成功地进行子宫肌瘤的切除,但悬吊式无气腹腹腔镜显示出更多的优势。

Objective：To compare the feasibility, safety, reliability and postoperative outcomes of myomectomy performed by gasless laparoscopy and conventional laparoscopy. Methods：Four hundred and seventy four women with symptomatic uterine myomas were ran- domly divided into gasless laparoscopy group （n = 239） and conventional laparoscopy group （n =235 ） in three hospital. All procedures were performed by three groups of surgeons. Operation duration, blood loss, the number of removed myomas, drainage volume, body temperature recov- ery, anal exsufflation and discharge time were recorded. Results：Both motheds were able to re- move the myomas. There were significant differences in indexes of operating time [ （65.5 ± 12.5 ） min vs （100.0±10.5） mini ,the number of myomas excised per patient（6.0±1.4 vs 2.2±1.3） ,intra-operative blood loss[ （ 110.5±30.5 ） ml vs （250.4±35.3） ml] and postoperative blood loss[ （120.5±23.0）ml and （260.2±31.5）ml] between gasless laparoscopy group and conventional laparoscopic group However, no significant difference was noticed in time for body temperature recovery, anal exsufflation time suitable for uterine myomectomy. It suggests conventional laparoscopy. and discharge time. Conclusion：Both methods are that gasless laparoscopy has more advantages than