经阴道子宫肌瘤剔除术及腹腔镜子宫肌瘤剔除术治疗子宫肌瘤的疗效比较

Comparison of effective rates of transvaginal hysteromyomectomy and laparoscopic hysteromyomectomy in treatment of hysteromyoma

目的比较经阴道子宫肌瘤剔除术(TVM)及腹腔镜子宫肌瘤剔除术(LM)治疗子宫肌瘤的疗效。方法选取2012年3月-2015年3月在吉林大学中日联谊医院妇产科就诊,符合手术条件的300例子宫肌瘤患者,随机分为LM组和TVM组,每组各150例患者。比较两组患者的手术时间、术中出血量、剔除子宫肌瘤个数及最大直径、术后留院时间、术后排气时间。结果 LM组除两例患者因肌壁间肌瘤缝合困难而转开腹手术外,另外148例患者均手术成功。TVM组患者均手术成功。两组术中出血量及剔除子宫肌瘤个数比较,差异均有统计学意义(均P<0.05);两组手术时间及剔除子宫肌瘤的最大直径比较差异均无统计学意义(均P>0.05)。术后,两组患者均未出现复发。两组术后排气时间及术后留院时间比较差异均无统计学意义(均P>0.05)。结论与LM相比,TVM的术中出血量少,剔除子宫肌瘤数量多,非常适合剔除肌壁间或较深部位的子宫肌瘤。LM则具有伤害小、术后不易发生粘连等优势。因此,手术医师要根据自身对某一术式的熟练程度和患者的客观病情来决定应用哪种手术方式最合适。

Objective To compare the effective rates of transvaginal myomectomy （TVM） and laparoscopic myomectomy （LM） in treatment of hysteromyoma. Methods A total of 300 patients with hysteromyoma meeting the operation criteria were selected from the hospi- tal from March 2012 to March 2015, then they were randomly divided into LM group and TVM group, 150 patients in each group. The opera- tion time, the amounts of blood loss during operation, the nubmers and maximal diameter of excised hysteromyoma, hospitalization time after operation, and postoperative exhausting time in the two groups were compared. Results In LM group, two patients converted to laparotomy due to difficult suture of intramural myoma, the other 148 patients completed operation successfully. In TVM group, the operation was completed successfully in all the patients. There were statistically significant differences in the amountof blood loss during operation and the nub- mer of excised hysteromyoma between the two groups （P〈0. 05 ） . There was no statistically significant difference in operation time and maxima/ diameter of excised hysteromyoma between the two groups （ P〉0. 05 ） . After treatment, no recurrence occurred. There was no statistically significant difference in hospitalization time after operation and postoperative exhausting time between the two groups （ P〉0. 05 ） . Conclusion Compared with LM group, the amount of blood loss during operation in TVM group is less, the nubmer of excised hysteromyoma is higher, which is suitable for excision of intramural myoma or hysteromyoma in deep parts of the uterus. LM has the advantages of small dam- age and less postoperative adhesion. The surgeons should select operation method according to the proficiency of surgery and objective condi- tion of the patients.