腹腔镜下大径线子宫肌瘤剔除术37例临床分析

Clinical analysis of 37 patients with laparoscopic myomectomy on large intramural myoma

目的：探讨腹腔镜下大径线子宫肌瘤剔除术的可行性及安全性。方法回顾分析2007年1月至2011年12月腹腔镜下大径线子宫肌瘤剔除术的37例大径线子宫肌瘤（子宫肌瘤最大直径大于或等于7 cm ，子宫体积大于14孕周）患者的临床资料（研究组），并与同期53例大径线子宫肌瘤经腹手术比较分析（对照组），随访预后情况。结果腹腔镜治疗组有28例在完全腹腔镜下完成，6例辅以腹部小切口完成手术，3例中转开腹。1例术后输尿管腹腔瘘，行二次开腹输尿管吻合术治愈。中转开腹与患者年龄、肌瘤大小、肌瘤个数、手术时间、术中出血量差异均无统计学意义（P＞0．05）。与对照组比较，手术时间、术中出血量和术后病率差异均无统计学意义（P＞0．05）；研究组术后恢复时间均少于对照组，差异有统计学意义（P＜0．05）。患者平均随访51个月（18～78个月），两组患者术后月经正常例数和术后妊娠例数差异均无统计学意义（ P＞0．05）。结论腹腔镜下大径线子宫肌瘤剔除术是安全可行的，但对术者手术技巧要求较高。

Objective To investigate the feasibility and safety of laparoscopic myomectomy in patients with large-diameter hyste-romyoma .Methods A retrospective analysis of data from 37 patients in which the uterus were larger than 14-week gestational size and the diameter of myoma was ≥7 cm treated by laparoscopic myomectomy from January 2007 to December 2011 in our hospital was conducted .The outcome of the operation were compared with that in 53 large-diameter hysteromyoma cases by abdominal sur-gery .Results 37 patients were carried out laparoscopic surgery in which 28 cases were treated successfully by total laparoscopy , and small abdominal incision was made in 6 cases .3 of the cases converted to open surgery .The ureteral abdominal fistula was ob-served in 1 case ,which was cured by a reoperation of abdominal ureteral anastomosis .All patients were successfully cured and re-tained the uterus .The cases converted to open had no significant correlation with the patient′s age ,the fibroids size ,fibroids num-ber ,operative time and blood loss volume（P〉0 .05） .Compared with the laparotomy group ,the operative time ,blood loss and post-operative morbidity were similar between groups （P〉0 .05） .Postoperative recovery times after laparoscopic group were less than the control group（P〈0 .05） .In the follow-up of 51 months（18 to 78） ,the laparoscopic myomectomy is equally effective with the laparotomy group in the number of cases of the postoperative normal menstruation and the postoperative spontaneous pregnancy . There were no statistically significant differences between the two groups （P〉0 .05） .Conclusion Laparoscopic myomectomy in pa-tients with large-diameter hysteromyoma is safe and feasible while excellent surgical skills were required for a successful surgery .