腹腔镜与开腹子宫肌瘤剔除术的比较

Comparison between Laparoscopic and Abdominal Myomectomy: a Report of 230 Cases

目的 与开腹子宫肌瘤剔除术比较探讨腹腔镜下子宫肌瘤剔除术的优越性.方法 回顾性分析我院2007年1月-2010年12月230例子宫肌瘤剔除术的临床资料,其中121例行腹腔镜下子宫肌瘤剔除术,109例行开腹子宫肌瘤剔除术,比较术中、术后及随访情况.结果 腹腔镜组术中出血量（85.7±10.4）ml,明显少于开腹组（110.0±13.8）ml（t=-15.053,P=0.000）,腹腔镜组术后肛门恢复排气时间短[（24.9±3.9）h vs.（32.1±6.7）h,t=-9.986,P=0.000],术后住院时间短[（4.8±0.7）d vs.（5.7±0.7）d,t=-9.678,P=0.000].2组患者子宫肌瘤残留率[1.7%（2/118） vs.2.8%（3/109）,χ^2=0.008,P=0.929]、复发率[18.6%（22/118）vs.16.5%（18/109）,χ^2=0.177,P=0.674）、妊娠率[14 4%（17/118） vs.20.2%（22/109）,χ^2=1.329,P=0.249]、分娩率[7.6%（9/118） vs.11.0%（12/109）,χ2=0.772,P=0.380]均无统计学差异.结论与开腹子宫肌瘤剔除术相比,腹腔镜子宫肌瘤剔除术具有明显的优势,可用于有生育要求的患者.

Objective To compare the clinical effect of laparoscopic myomectomy and abdominal myomectomy. Methods A retrospective analysis was carried out on 230 patients with uterine fibroids from January 2007 to December 2010, including 121 cases undergoing laparoscopic myomectomy and 109 cases undergoing abdominal myomectomy. The intraoperative, postoperative and followup conditions were compared between the two groups. Results The blood loss in laparoseopic group was （ 85.7 ± 10.4） ml, which was significantly less than that in transabdominal group [ （ 110.0 ± 13.8 ） ml; t = - 15. 053,P = 0. 000 ] ; the postoperative exhaust time in laparoscopic group was shorter than that in transabdominal group[（24.9 ±3.9） h vs. （32. 1 ±6.7） h,t = -9.986,P = 0. 000] ; the postoperative hospital stay in laparoscopic group was shorter than that in transabdominal group [ （4. 8± 0. 7 ） d vs. （5.7 ± 0.7） d,t = -9. 678,P = 0. 000 ]. No statistical difference was found between the two groups in residual rate of uterine fibroids [1.7% （2/118） vs. 2.8% （3/109）,X^2 =0.008,P=0.929], recurrence rate [18.6% （22/118） vs. 16.5% （18/109）,X^2 = 0.177,P=0,674], pregnancy rate [14.4% （17/118） vs. 20.2% （22/109）,X^2 =1.329,P=0.249],and delivery rate [7.6% （9/118） vs. 11.0% （12/109） , X^2=0. 772,P =0. 3801. Conclusion Laparoscopic myomectomy is superior to transabdominal myomectomy, suitable for the patients with fertility requirements.