腹腔镜下子宫肌瘤剔除术手术难度评分系统的临床应用

Clinical Application of Difficulty Scoring System for Laparoscopic Uterine Fibroids Surgery

目的 利用腹腔镜子宫肌瘤切除术（laparoscopic myomectomy,LM）手术难度评分系统（difficulty degree index,DDI）评估LM的难度,探讨合理的手术方式.方法 选取172例在我科行LM患者为研究对象,依据DDI评分系统按照评分高低分为低风险组（〈5分）78例,中风险组（5~7分）69例和高风险组（≥8分）25例,观察并比较各组手术中转开腹、术后并发症发生率以及手术时间、术中出血量、术后肛门排气时间及住院时间.结果 3组中转开腹及围手术期并发症发生率差异有统计学意义（P〈0.05）,高风险组、中风险组中转开腹率、并发症发生率显著高于低风险组.高风险组手术时间、Hb差值、住院时间显著高于中风险组和低风险组,而中风险组仅手术时间长于低风险组,Hb差值、肛门排气时间、住院时间比较差异无统计学意义.结论 DDI评分可较好预测LM的结局,低、中风险患者建议腹腔镜治疗,高风险患者需谨慎,必要时中转开腹.

Objective To evaluate laparoscopic uterine fibroids rejecting operation （laparoscopic myomectomy, LM） difficulties by laparoscopic hysteromyoma resection operation difficulty scoring system （DDI）, and to discuss the reasonable operation method. Methods 172 cases of laparoscopic uterine fibroids in our department were enrolled as the research objects, and divided into low risk group （〈5 points） of 78 cases, medium risk group （5-7 points） 69 cases and high risk group of 25 cases of （〉8 points） according to the operation difficulty score criteria. Observed and compared the transfer laparotomy surgery, the incidence of postoperative complications and operation time, intraoperative blood loss, postoperative anal exhaust time and the hospital stay. Results Among the three groups the transfer laparotomy incidence of perioperative complications had significant difference （P〈0.05）. In high risk and medium risk groups, the transit operation rate and complication rate were significantly higher than in low risk group. In high risk group, the operation time, Hb difference, and length of hospital stay were significantly greater than in medium risk and low risk groups. The medium risk group had longer operation time than low risk group, but had no differences in Hb, the length of hospital stay, and anal exhaust time. Conclusion The DDI score can better predict the outcomes of laparoscopic uterine fibroids surgery. The low and medium risk patients are recommended laparoscopic treatment, while high-risk patients need to be careful, and transit operation may be needed when necessary.