手术治疗特殊部位子宫肌瘤82例临床分析

Clinical analysis of surgery for 82 cases uterine fibroids in specific parts

目的探讨特殊部位子宫肌瘤的临床特点及腹腔镜手术治疗的可行性和优越性。方法回顾性分析2010年1月至2014年1月,山西医科大学第二医院妇产科收治的82例特殊部位子宫肌瘤患者的临床资料,其中52例行腹腔镜下子宫肌瘤切除术(观察组),30例行开腹子宫肌瘤切除术(对照组),比较两组患者术前、术中及术后各项指标的情况。结果 82例特殊部位子宫肌瘤中,53例(64.63%)经体检发现,仅7例(8.54%)表现为阴道不规则流血及月经改变。所有患者术前均联合超声检查进一步诊断并成功行子宫肌瘤切除术。两组患者肌瘤大小及术前术后诊断符合率差异无统计学意义;两组患者术前输尿管导管放置、手术时间、术中出血量、术中输血率、平均住院时间、手术费用及术后膀胱直肠功能恢复时间比较,差异有统计学意义(P<0.05);两组患者超声及生育功能随访比较,差异无统计学意义。结论特殊部位子宫肌瘤临床症状不典型,多由体检或妇科检查时发现,影像学检查是特殊部位子宫肌瘤诊断的重要依据。腹腔镜手术治疗是一种经济安全有效的术式。

Objective To investigate the feasibility and superiority of the clinical features of laparoscopic surgery for specific parts of uterine fibroids. Methords A retrospective analysis of the clinical data of 82 cases of patients with uterine fibroids from the Second Hospital of Shanxi Medical University was conducted. Among 82 patients, 52 underwent laparoscopic myomectomy （ study group） and 30 abdominal myomectomy （the control group ）. The two groups were compared by the indicators of preoperative, intraoperative and postoperative. Results 53 cases （64.63%） of the 82 cases were discovered by physical examination, only 7 cases （8.54%） showed abnormal vaginal bleeding and menstrual changes. All patients eonbined with preoperative uhrasonography for further diagnosis, were successfully performed the resection of myoma of uterus. Between two groups , the myoma size and preoperative and postoperative diagnostic accordance rate had no significant difference（ P 〉 0. 05 ） ; however, whether to place the ureteral catheter or not, operation time, intraoperative bleeding volume, intraoperative blood transfusion rate, average hospitalization time, the cost of operation and postoperative recovery time of bladder rectum function were statistically significant （ P 〈 0.05 ） ; ultrasound and reproductive function had no statistical significance in follow-up process. Conclusion Specific parts of uterine fibroids had not typical clinical symptoms. The majority of cases are discovered by physical examination and gynecological examination, and imaging studies are an vital basis for them. Laparoseopic surgery is an effective, safe and affordable method.