开腹与腹腔镜子宫腺肌病灶切除术的临床比较

Clinical comparative study of laparotomy and laparoscopic adenomyomectomy

目的研究开腹及腹腔镜子宫腺肌病灶切除术的临床治疗效果及安全性。方法采用前瞻性队列研究方法,以2010年1月至2014年1月在北京妇产医院妇科微创中心行子宫腺肌病灶切除术104例患者为研究对象,其中开腹组34例,腹腔镜组70例,分析比较两组的手术时间、术中出血量、术前术后血红蛋白变化,术后最高体温、术后住院时间、术后痛经评分、月经量评分及复发率。结果腹腔镜组的术后住院时间明显短于开腹组[(5.6±1.4)d vs(6.4±1.1)d],差异有统计学意义(P<0.05);两组的手术时间、术中出血量、术后术前血红蛋白变化比较,均差异无统计学意义(P>0.05);术后2年,开腹组的复发率显著低于腹腔镜组[1/34(1.4%)vs 6/70(17.6%),P<0.05)];两组的月经评分及痛经评分比较,差异无统计学意义(P>0.05)。结论腹腔镜及开腹子宫腺肌病灶切除术均是安全有效的保守性治疗方式;腹腔镜子宫腺肌病灶切除术较开腹手术恢复快,但复发率高,因此需要谨慎选择适应证。

Objective By comparing clinical date of laparotomy and laparoscopic adenomyectomy, to expore the clinical application value of laparoscopic adenomyectomy. Methods A prospective cohort study of patients undergoing laparoscopic adenomyectomy（ n = 70） was carried out in Beijing Obstetrics and Gynecology Hospital from Jan. 2010 to Jan. 2014. 34 patients undergoing laparotomy adenomyectomy in the same period was selected as the control group. For the comparision of the two groups, the operation duration, blood loss during operation, postoperative maximum temperature, the length of postoperative hospitalization, postoperative hemoglobin change, postoperative dysmenorrhea score, menstrual score and recurrence rate were observed. Results Compared with laparotomy group, the patients of laparoscopic group show significant shorter length of postoperative hospitalization [ （5.6 ± 1.4）d ] vs （6.4 ± 1.1）d ] （ P 〈 0. 05 ） . There was no significant difference in the operation duration, blood loss during operation, postoperative maximum temperature, postoperative hemoglobin change between the two groups （P 〉 0. 05 ）. The laparotomy group show significant lower recurrence rate than that in the laparoscopic group [ 1/34 （1.4%） vs 6/70 （11.6%） ,P 〈0. 05）]. There was no significant difference in menstrual score and dysmenorrhea score between two groups two years after operation. Conclusions Laparoscopic adenomyectomy are safty and effective conservative surgery. Recovery after laparoscopic adenomyectomy is faster than laparotomy, but it’s recurrence rate is higher. Therefore, it is necessary to choose indications carefully.