腹腔镜下腹壁小切口子宫肌瘤剥除术的临床效果

Laparoscopically assisted myomectomy for fibroid

目的 探讨腹腔镜下腹壁小切口子宫肌瘤剥除术在临床的治疗效果及应用.方法 采用前瞻性队列研究方法,分别连续纳入2009年1月至2012年1月到我院妇产科患子宫肌瘤的育龄期妇女接受腹腔镜下腹壁小切口子宫肌瘤剥除术60例、接受腹腔镜肌瘤剥除术60例和接受阴式肌瘤剥除术30例.分为小切口组、腹腔镜组、阴式组,随访3年.比较三组手术情况、术后检测、术后实验室检查结果、住院情况及3年后的随访结果.结果 在校正了肿瘤情况后,与小切口组对比,在腹腔镜组中,患者失血量显著增长,手术时间显著增长,费用显著增多,但住院天数显著减少（P〈0.05）,阴式组中,患者手术时间显著增长,肛门排气时间显著增长,但住院天数显著减短（P〈0.05）.在校正了术前数值后,腹腔镜组及阴式组患者子宫动脉阻力指数RI显著低于小切口组,腹腔镜组患者术后LH显著高于小切口组（P〈0.05）,术后两组其他激素值未见显著差异（P〉0.05）.术后随访结果三组未见显著差异（P〉0.05）,但提示腹腔镜复发率和术后妊娠子宫破裂率可能较高.结论 三种手术方式各有利弊,应根据具体情况选择术式,腹腔镜下腹壁小切口子宫肌瘤剥除术与其他两种相比,适用广泛,具有较好的疗效和预后,能够减低手术难度和医疗费用,值得临床广泛应用.

Objective To explore the clinical effect and clinical application of laparoscopically assisted myomectomy （LAM） in the treatment of fibroid.Methods A prospective cohort study was conducted.60 patients with fibroid undergoing LAM （LAM group）, 60 undergoing laparoscopical myomectomy （LM）（LM group）, and 30 undergoing transvaginal myomectomy （TVM）（TVM group） at our hospital from January, 2009 to January, 2012 were included into this study and were followed up for 3 years.The indexes of the surgery, laboratory indexes, and the prognosis were compared between these three groups.Results After adjusting the characters of tumor, the bleeding volume was obviously larger, the operation time was markedly longer, and the cost was much higher, but the hospital stay was much shorter in the LM group than in the LAM group （P〈0.05）;the operation time and the time of anal exsufflation were obviously longer but the hospital stay was much shorter in the TVM group than in the LAM group （P〈0.05）.After adjusting the preoperative indexes, RI was significantly lower in the LM group and the TVM group than in the LAM group and LH was significantly higher in the LM group than in the LAM group （P〈0.05） and wasn＇t statistically different between the LM group and TVM group （P〈0.05）.There were no significant differences in follow-up results between these three group （P〉0.05）.Conclusions The three kinds of operations have their own advantages and disadvantages, which should be selected according to specific situation.Compared with the other two, LAM is used more widely, has a better clinical effect and prognosis,can reduce the operation difficulty and medical expense, so it is worth being clinically generalized.