不同止血方式在腹腔镜子宫肌瘤剔除中的应用分析

Application and analysis of different hemostatic methods during laparoscopic myomectomy

目的探讨采用不同止血方式在腹腔镜子宫肌瘤剔除术中的止血效果差异。方法选择妇产科2010年1月至2014年6月收治的具有手术指征的肌壁间子宫肌瘤患者320例,随机分为A、B、C、D 4组,每组80例。A组患者采用肌瘤蒂部套扎止血,B组患者采用肌瘤周围注射12 IU垂体后叶素止血,C组采用肌瘤蒂部套扎+注射20 IU的缩宫素止血,D组采用注射垂体后叶素+肌瘤蒂部套扎止血,比较4组患者止血效果。结果 A、B、C、D组患者的手术时间比较差异无统计学意义(P>0.05);D组患者的术中出血量、术后引流量均显著低于A、B、C组(P<0.05);B组患者术中出血量及术后引流量显著低于A、C组(P<0.05)。A、B、C、D组患者术后肛门排气时间比较差异无统计学意义(P>0.05);术后D组患者体温恢复时间、血红蛋白下降值、术后住院时间均显著低于A、B、C组(P<0.05),A、B、C组之间术后体温恢复时间、血红蛋白下降值、术后住院时间比较差异均无统计学意义(P>0.05)。结论腹腔镜子宫肌瘤剔除术中应用肌瘤周围注射12 IU垂体后叶素联合肌瘤蒂部套扎止血具有较好的临床疗效。

Objective To explore hemostasis effect difference of different ways to stop bleeding during laparoscopic myomectomy. Methods A total of 320 patients with myoma of uterus muscle wall syndrome refers to the operation in Department of Gynaecology and Obstetrics from January 2010 to June 2014 were selected and were randomly divided into four groups of group A,B,C and D,with 80 cases in each group. Fibroids pedicle ligation hemostasis was used in group A,injecting 12 IU myoma pituitrin around the myoma was used in group B. The patients in group C were treated with fibroids pedicle ligation ＋20 IU injection of oxytocin hemostasis,and the patients in group D were treated with injection of pituitrin ＋ fibroids pedicle ligation hemostasis. Hemostatic effect among the four groups was compared. Results There was no statistical significance of operation time among the four groups（ P〈0. 05）. The amount of intraoperative bleeding and postoperative drainage in group D were significantly lower than those of group A,B and C（ P〈0. 05）,which were significantly lower in group B compared with group A and C（ P〈0. 05）. No statistical significance of postoperative anal exhaust time was found among group A,B,C and D（ P〈0. 05）. The postoperative recovery time of body temperature,descent of hemoglobin and postoperative hospitalization time in group D were significantly lower than those in group A,B and C（ P〈0. 05）,which had no statistically significance among group A,B and C（ P〈0. 05）. Conclusion Application of vasopressin injection 12 IU around fibroids joint bleeding fibroids pedicle ligation has better clinical efficacy on laparoscopic myomectomy.