阴道超声在腹腔镜多发子宫肌瘤剔除术中的应用价值

The Clinical Value of Transvaginal Ultrasonography in Laparoscopic Myomectomy

目的探讨在腹腔镜剔除子宫多发肌瘤术中应用阴道超声减少肌瘤残留及降低复发的临床价值。方法2010年1月一2011年12月85例多发子宫肌瘤按入院日期单、双号分为阴道超声引导腹腔镜组（n=42）与腹腔镜组（n=43）。阴道超声引导腹腔镜组于腹腔镜手术后经阴道超声引导将残留的子宫肌瘤继续在腔镜下剔除。结果2组术中出血量、术后排气时间、术后住院时间无统计学差异（P〉0．05）。阴道超声引导腹腔镜组术中发现11枚残留肌瘤，均为肌壁间肌瘤，肌瘤直径1．5—2．5cm。腹腔镜组7例复发（16．3％，7／43），阴道超声引导腹腔镜组1例复发（2．4％，1／42），均为肌壁间肌瘤，2组复发率比较无统计学差异（x2=3．321，P=0．068）。结论阴道超声引导下腹腔镜子宫肌瘤剔除术可以最大限度地避免肌瘤残留。

Objective To investigate the clinical value of transvaginal uhrasonography in reducing residue and recurrence of fibroid in laparoscopic myomectomy. Methods From January 2010 to December 2011, a total of 85 patients were enrolled in this study. They were divided into two groups according to the odd or even number of admission date, transvaginal uhrasonography-guided laparoscopic myomectomy group （ n = 42）, and laparoscopic myomectomy group （ n - 43）. The residual fibroids were removed under laparoscope in the transvaginal uhrasonograpby-guided laparoscopic myomectomy group after laparoscopic myomectomy. Results No statistical difference was found between the two groups in intraoperative blood loss, postoperative exhaust time, and postoperative hospital stay（P 〉 0. 05 ）. In the transvaginal ultrasonography-guided laparoscopic myomectomy group, there were 11 residual fibroids with a diameter of 1.5 - 2.5 cm. There were 7 cases of recurrent fibroids （ 16.3% ,7/43） in the laparoscopic group and 1 case of recurrent fibroid （2.4%, 1/42） in the transvaginal uhrasonography-guided laparoscopic myomectomy group. All the fibroids were intramural myomas. No statistical difference was found between the two groups in the recurrence rate （X2 = 3. 321, P = 0. 068 ）. Conclusion Transvaginal ultrasonography-guided laparoscopic myomectomy is better approach for eliminating residual fibroids and lowering the recurrence rate.