悬吊式腹腔镜与开腹手术子宫肌瘤剔除术的比较研究

COMPARISON BETWEEN SUSPENDED LAPAROSCOPY AND CONVENTIONAL LAPAROTOMY IN TREATING UTERINE MYOMECTOMY

目的比较悬吊式腹腔镜与开腹手术子宫肌瘤剔除的临床疗效和对凝血功能的影响。方法选择2015年1月-2016年6月在该院妇产科收治的子宫肌瘤患者220例，其中纳入本次研究的82例，分为观察组（悬吊式腹腔镜组）48例，对照组（开腹组）34例。比较手术时间、术中出血量、肛门排气时间、平均住院时间、术后体温升高持续时间：检测分析二组患者术前、术后凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）、D-二聚体（D—D）、抗凝血酶Ⅲ（ATⅢ）的变化。结果观察组手术时间、术中出血量、平均住院时间和术后体温升高持续时间低于对照组，差异有统计学意义（t=3．108～5．236，Pd0．05）；观察组和对照组术后24hPT、APTT、ATⅢ均低于术前水平，而FIB、D—D均高于术前水平，差异有统计学意义（t：2．873～4．716，P〈0．05）；观察组术后24hPT、APTT、ATⅢ水平高于对照组，而FIB、D—D则低于对照组，差异有统计学意义（t=2．9874．238，Pd0．05）。结论悬吊式腹腔镜优于传统开腹手术，损伤小，可降低深静脉血栓发生，值得推广应用。

Objective To compare the curative efficacy and the effect on coagulation system of myomectomy performed by suspended laparoscopy and traditional laparotomy. Methods A analysis was made on clinical data of 48 cases of suspended gasless laparoscopyl the observation group） and 34 cases of traditional lapa- rotomy （the control group） from Jan 2015 to Jun 2016. Main outcome measures were operating rime,the a- mount of blood loss, exsufflation and discharge, postoperative hospital stay, postoperative fever. Compared the changes of PT, APTT, FIB,D- D and AT- Ⅲ before operation and one day after surgery. Results The operation time,intra- operative blood loss, postoperative hospital stay, postoperative fever in the observa- tion group were lower than those in the control group（ t = 3. 108-5. 236, P〈0.05 ）. One day after surgery, PT,APTT and AT Ⅲ in the observation group and the control group were lower than before operation, however, FIB and D- D were higher than before operation （t = 2. 873-4. 716, P〈0.05）. One day after sur- gery,PT,APTT and AT Ⅲ in the observation group were higher than those in the control group, whereas FIB and D- D were lower than those in the control group（ t = 2. 987-4. 238, P〈0.05）. Conclusion It sug- gests that suspended laparoscopy has more advantages than conventional laparotomy. Suspended laparosco- py can reduce the incidence of VTE and damage to the body. It is worth popularizing application. Key words Suspended laparoscopic; Laparotomy; Myomectomy; D- dimer ; Antithrombin Ⅲ activity