宫腔镜与腹腔镜下行子宫粘膜下肌瘤切除术的临床疗效比较

Comparision about the clinical effect between hysteroscopic and laparoscopic submucosal uterine myomectomy

目的比较和评估宫腔镜与腹腔镜下行子宫粘膜下肌瘤切除术的临床疗效。方法选取我院2012年1月~2014年12月收治的临床诊断为子宫粘膜下平滑肌瘤需手术治疗的患者共125例,按照手术方式不同分为两组,宫腔镜组60例,腹腔镜组65例,比较两组患者的手术时间、术中出血量、肛门排气时间、住院时间、术后3个月宫腔镜复查预后情况和宫腔粘连情况。结果宫腔镜组随访发现2例肌瘤残存,两组患者手术时间和术中出血量差异无统计学意义（P〉0.05）,宫腔镜组的肛门排气时间和住院时间低于腹腔镜组（P〈0.05）;当肌瘤直径≤30mm时,宫腔镜组的手术时间和术中出血量均少于腹腔镜组（P〈0.05）,肛门排气时间和住院时间宫腔镜组也少于腹腔镜组（P〈0.05）;当肌瘤直径30-50mm时,宫腔镜组的手术时间和术中出血量与腹腔镜组差异无统计学意义（P〉0.05）,但肛门排气时间和住院时间宫腔镜组少余腹腔镜组（P〈0.05）;当肌瘤直径≥50mm时,宫腔镜组的手术时间和术中出血量要多于腹腔镜组（P〈0.05）,肛门排气时间和住院时间两者差异无统计学意义（P〉0.05）。术后3个月复查两组患者均预后良好。结论宫腔镜和腹腔镜治疗子宫粘膜下肌瘤都是安全、有效的,对宫腔镜下切除困难的大粘膜下肌瘤（≥50mm）,为避免子宫穿孔、肌瘤残余等风险,优先选择腹腔镜手术,对带蒂及体积较小的粘膜下肌瘤（〈50mm）,仍应将宫腔镜手术作为首选。

Objective Comparison and evaluation of clinical curative effect between hysteroscopy and laparoseopy submucosal uterine myomectomy. Methods 125 cases who were diagnosed with submucosal uterine fibroids and needed to be treated surgically in our hospital from January 2012 to December 2012 were selected and divided into two groups according to the operation way. One was hysteroseopy group with 60 eases, the other was laparoscopie group with 65 eases. Operation time, intraoperative blood loss, hospital stays, anal exhaust time, prognosis and intrauterine adhesions after 3 months were compared between two groups. Results follow-up found that there were 2 cases in hysteroscopy group with remaining myoma. There were no statistically significant differences in operative time and intraoperative blood loss between two groups （P〉0.05） Anal exhaust time and hospitalization time in hysteroscopy group were lower than those in the laparoseopic group （P〈0.05）; When the diameter of fibroids was below 30 wan, the operative time and intraoperative blood loss, anal exhaust time and hospital stay in hysteroscopy group were less than those in the laparoscopie group （P〈0.05）; When fibroids were larger than 30-50 mm, there were no statistically significant differences in operative time and intraoperative blood loss between hysteroseopy group and laparoscopic group （P〉0.05）, but the anus exhaust time and hospital stay in hysteroscopy group were less than those in laparoscopic group （P〈0.05）; When the diameter of fibroids was above 50 mm, operative time and intraoperative blood loss in hysteroseopy group were more than those in laparoseopie group （P〈0.05）, anal exhaust time and hospital stay had no statistically significant difference between two groups （P〉0.05）. Conclusion Submucosal uterine fibroids was treated by Hysteroscopic and laparoscopie therapy, which was safe and effective. For big submueosal uterine fibroids （50 mm or higher）, the laparoscopie surgery should be the first choice in order to avoid perforation, uterine fibroids residual risk, but for the pedicle and small submueosal fibroids （〈 50 mm）, hysteroseopy surgery should still be preferred.