经腹子宫肌瘤剔除术与腹腔镜子宫肌瘤剔除术远期疗效比较

Comparison of Long Term Effects of Transabdominal Myomectomy and Laparoscopic Myomectomy

目的比较经腹子宫肌瘤剔除术与腹腔镜子宫肌瘤剔除术的远期疗效。方法选择2010年1月至2013年1月恩施自治州中心医院妇产科收治的250例子宫肌瘤患者,根据随机数字表法分为经腹组和腹腔镜组,每组125例。经腹组采用经腹子宫肌瘤剔除术治疗,腹腔镜组采用腹腔镜下子宫肌瘤剔除术治疗,记录两组患者的术中指标(手术时间、术中出血量、剔除肌瘤个数以及最大直径、术中并发症)以及术后指标(住院时间、肛门排气时间、下床活动时间、术后体温最高值、术后并发症),应用SF-36生活质量问卷调查表评估两种手术对患者生活质量的影响。结果腹腔镜组患者术中出血量显著少于经腹组[(78±21)mL比(128±32)mL],手术时间显著长于经腹组[(116±27)min比(100±23)min],肌瘤剔除个数少于经腹组[(2.9±0.6)个比(3.5±0.8)个],差异有统计学意义(P<0.05),剔除肌瘤的最大直径比较,差异无统计学意义[(6.5±1.7)cm比(6.3±1.7)cm](P>0.05);腹腔镜组患者术后排气时间、下床活动时间以及住院时间均显著少于经腹组[(40±6)h比(56±4)h、(45±5)h比(54±5)h、(8.3±2.1)d比(10.9±3.8)d](P<0.05);经腹组术中及术后并发症发生率与腹腔镜组比较差异均无统计学意义[10.4%(13/125)比8.8%(11/125)、18.4%(23/125)比16.0%(20/125)](P>0.05),此外,经腹组切口愈合不良率显著高于腹腔镜组[5.6%(7/125)比0.8%(1/125)](P<0.05);两组患者术前和术后的各维度评分、总评分比较,差异均无统计学意义(P>0.05),术后两组患者的躯体职能、社交功能、情感职能以及精神健康等的评分均较术前提高,差异有统计学意义(P<0.05),躯体功能、躯体疼痛、一般健康状况、精力以及总分与术前比较差异均无统计学意义(P>0.05)。结论与经腹子宫肌瘤剔除术相比,腹腔镜子宫肌瘤剔除术具有手术创口小、术中出血量少、术后恢复快等优点,值得推广应用。

Objeclive To compare the long term effects of transabdominal myomeetomy and laparos- copic myomectomy. Methods Total of 250 uterine fibroid patients treated in Enshi Central Hospital from Jan. 2010 to Jan. 2013 were included in the study, and divided into a transabdominal group and a laparoscop- ic group according to the random number table method, 125 cases in each group. The transabdominal group was treated with transabdominal myomectomy and the laparoscopic group was treated with laparoscopic myo- mectomy. The intraoperative measures （ operation time, blood loss, maximum diameter and number of fibroids removed, complications） and postoperative measures （ hospital stay, anal exhaust time, activity time, highest temperature value, complications） of the two groups were recorded and contrasted. Short Form-36 （SF-36） questionnaire was used for evaluation preoperative and postoperative quality of life. Results The blood loss of the laparoscopic group was significantly less than the transabdominal group[ （78 ± 21 ） mL vs （128 ± 32） mL] ,the operative time was significantly longer than the transabdominal group [ （116 ± 27 ） rain vs （100 ± 23） mini, the number of fibmlds removed was significantly less than the transabdominal group [ （2.9 ± 0.6） vs （ 3.5 ± 0.8 ） ] （P 〈 0 05 ）. The maximum diameter of fibroids removed in the lapamscopic group was（6. 5 ± 1.7） cm and in the transabdominal group was （6. 3 ± 1.7） cm,the difference was not statistically significant （ P 〉 0. 05 ）. The M, exhaust time, ambulation time and hospital stay of the laparoscopic group were significantly sholter than the transabdominal group[ （40 ±6） h vs （56 ±4） h, （45 ±5） h vs （54 ±5） b,（8.3 ±2.1） d vs （10. 9 ±3.8） d] ,the differences had statistical significance（P 〈0. 05）. The overall intraoperative and postoperative complications incidence of the laparoseopic group were 10.4% （ 13/ 125 ） and 18.4% （23/125）, of the transabdominal group were 8.8% （ 11/125 ） and 16.0% （ 20/125 ）, the differences were not statistically significant （ P 〉 0. 05 ）. The faulty union rate of the transabdominal group [5.6% （7/125） ] was significantly higher than the laparoscopic group [0.8 % （ 1/125 ） ]. The dimension scores and total score of the two groups before and after operation had no statistically significant difference （ P 〉 0. 05 ）. After surgery, the scores of physical role, social function, emotional function and mental health of both groups were higher than before surgery（ P 〈 0. 05 ） , scores of physical functioning, body pain, general health ,energy and the total score compared with before surgery had no statistically significant difference （P 〉0. 05）. Cotlelltion Compared with the transabdominal myomectomy, laparoscopic myomectomy has obvious advantages such as little trauma.less bleedin and ouick recoverv, andit is worthy of myornotion.