开腹和腹腔镜剔除子宫肌瘤的复发和受孕率比较分析

The analysis of recurrence and pregnancy rate for hysteromyomectomy by laparotomy and laparoscopy

目的研究开腹术与腹腔镜术剔除子宫肌瘤后的疗效并对两者术后复发情况及受孕情况进行对比分析。方法选择该院2009年1月—2011年2月收治的子宫肌瘤患者共40例,均采用手术治疗,随机分为开腹手术剔除组与腹腔镜手术剔除组各20例,术后随访3年,分别比较两组患者术后肌瘤复发情况、受孕情况,手术时间、术中出血情况、住院天数等。结果开腹组术中出血量(102.4±12.5)mL、手术时间(107±18.0)min较开腹组多;住院天数(4.0±0.5)d较开腹组少,差异有统计学意义,P<0.05。两组患者术后复发情况比较差异无统计学意义,P>0.05,腹腔镜组7例不孕不育症患者术后受孕5例,受孕率为71.4%,开腹组8例不孕不育症患者术后受孕2例,受孕率为25%,两组受孕率比较差异有统计学意义,P<0.05。结论肌瘤复发因素与肌瘤大小,数量等因素有关,腹腔镜子宫肌瘤剔除术为有生育需求的单发子宫肌瘤患者的首选手术方式。

Objective To research the curative effects of hysteromyomectomy by laparotomy and laparoscopy, and to compare and analysis the postoperative recurrence and pregnancy rate. Methods From Jan 2009 to Feb 2011, forty patients with hysteromyoma for operation in our hospital were randomly into two groups. Twenty of them received laparoscopy and the other half received laparotomy. In the 3-year follow-up period, we compared the recurrence, pregnancy rate, operation time, transoperative bleeding and hospital stay. Results The amount of transoperative bleeding（ 102.4±12.5） mL and operation time（ 107 ±18.0） rain of the group by laparotomy are more than that by laparoscopy. But the hospital stay （4.0 ±0.5） days is less, with statistical significance（P 〈0.05）. There were no significant difference of postoperative recurrence between the two groups（ P 〉0.05 ）. Seven infertile female patients were pregnant after laparoscope（ the pregnaucy rate is 71.4% ）. And after laparotomy, eight infertile patients were pregnant （ the pregnancy rate is 25% ）. The difference of pregnancy rate between two groups has statistical significance（P 〈 0.05 ）. Conclusion The recurrence rate of uterine myosma is closely related to the number and size of fibroids. Hysteromyomectomy under the laparoscope is the first choice of patients with single fibroid who want to preserve their reproductive capacity.