腹腔镜子宫肌瘤剥除术149例临床分析

Clinical analysis of 149 cases of laparoscopy myomectomy

目的探讨腹腔镜下子宫肌瘤剥除术的临床效果。方法回顾性分析2009年1月至2013年1月江阴市人民医院妇科进行的149例腹腔镜下子宫肌瘤剥除术的临床资料,其中单发性肌瘤89例,多发性肌瘤60例。结果多发性子宫肌瘤手术时间和术中出血量(113.90±22.81min、109.71±43.67mL)高于单发性子宫肌瘤(60.51±19.52min、62.69±16.67mL),差异有统计学意义(z值分别为-9.792、-8.766,均P<0.05)。子宫后壁肌瘤平均手术时间(76.82±14.28min)明显长于子宫前壁及子宫底部子宫肌瘤(50.68±14.94min、50.00±15.90min),差异有统计学意义(k=40.717,P<0.05)。肌壁间肌瘤平均手术时间及术中出血量(86.95±14.44min、77.28±19.03mL)高于浆膜下肌瘤及阔韧带肌瘤(53.79±17.41min、37.90±12.93mL和81.42±6.24min、52.86±18.68mL),差异均具有统计学意义(k值分别为43.443、52.466,均P<0.05)。直径≥5cm肌瘤剥除手术时间和术中出血量(85.84±17.45min、87.14±23.07mL)明显高于直径<5cm肌瘤(49.55±11.17min、39.14±13.23mL),差异均有统计学意义(z值分别为-7.092、-7.402,均P<0.05)。结论在充分的术前评估和良好的手术操作技巧下,腹腔镜下子宫肌瘤剥除术是治疗子宫肌瘤的良好方法。

Objective To discuss the clinical effect of laparoscopic cystectomy of uterine fibroids .Methods A retrospective analysis was conducted on the data of 149 patients undergoing laparoscopic cystectomy of uterine fibroids during the period of January 2009 to January 2013 in gynecology department of Jiangyin People ＇s Hospital, including 89 cases of single uterine fibroids and 60 cases of multiple uterine fibroids.Results The operative time for multiple uterine fibroids （113.90 ±22.81min） was longer than that for single uterine fibroids （60.51 ±19.52min）, and the intraoperative blood loss was more （109.71 ±43.67mL vs 62.69 ±16.67mL）.The differences between them were significant （z value was -9.792 and -8.766, respectively, both P〈0.05）.The mean operation time for uterine fibroids at posterior uterine wall （76.82 ±14.28min） was obviously longer than that for uterine fibroids at anterior wall and at the bottom of uterine （50.68 ±14.94min, 50.00 ±15.90min）, and the difference was significant （k=40.717,P〈0.05）.The mean operative time for intramural fibroids （86.95 ±14.44min） was longer than that for subserosal fibroids and for broad ligament fibroids （53.79 ±17.41min, 81.42 ±6.24min）, and the intraoperative blood loss （77.28 ±19.03mL） was more （37.90 ±12.93mL and 52.86 ±18.68mL, respectively）.There were significant differences （k value was 43.443 and 52.466, respectively, both P〈0.05）.Stripping time for fibroids with diameter≥5cm and diameter 〈5cm was 85.84 ±17.45min and 49.55 ±11.17min, respectively, and the intraoperative blood loss for fibroids with diameter≥5cm and diameter 〈5cm was 87.14 ±23.07mL and 39.14 ±13.23mL, respectively.The differences were statistically significant （z value was -7.092 and -7.402, respectively, both P 〈0.05）.Conclusion With sufficient preoperative assessment and good operative technique , laparoscopic cystectomy is a good surgical treatment for uterine fibroids .