子宫动脉阻断术与术前应用小剂量曲普瑞林在子宫腺肌症腹腔镜下病灶切除术中的效果比较

Effects comparison between the uterine arterial occlusion and preoperative application of small dosage of Triptorelin in laparoscopic resection of adenomyosis

目的分析腹腔镜下子宫腺肌症病灶切除术联合术前小剂量曲普瑞林皮下注射与术中子宫动脉阻断术的临床效果差异。方法收集2014年1月~2016年10月同济大学附属同济医院妇科收治的子宫腺肌症行腹腔镜下病灶切除术的患者,根据术前及术中处理方式将患者分为A组和B组,A组术中行子宫动脉阻断(n=40),B组术前使用小剂量曲普瑞林(n=30)。比较两组患者手术时间、术中出血量、术后肠功能恢复、术后并发症、住院时间、术前术后血红蛋白变化、术后血清钾浓度、住院费用等的差异。结果两组术后住院时间、术后血钾浓度、手术前、后血红蛋白比较,差异均无统计学意义(P>0.05);与A组比较,B组手术时间更短,术中出血量更少、术后肠道功能恢复时间更短,但住院费用更高,差异均有统计学意义(P<0.05)。结论与腹腔镜下子宫腺肌症病灶切除术术中联合子宫动脉阻断术比较,术前使用小剂量曲普瑞林手术时间短,术后肠功能恢复快,出血量少,更安全、有效,值得临床推广。

Objective To analyze the difference of the clinical effects of laparoscopic adenomyosis resection combined with small-dose Triptorelin injected subcutaneously before operation and intraoperative uterine artery occlusion. Methods From January 2014 to October 2016, patients with adenomyosis who underwent laparoscopic resection in Tongji Hospital, Tongji University were divided into two groups according to intraoperative uterine artery ligation（group A, n = 40） and preoperative use of small-dose Triptorelin group B, n =30）, and then the differences of surgery time, blood loss in surgery, intestinal function, postoperative complications, length of stay, hemoglobin change of preoperative and postoperative, potassium concentration of postoperative and hospitalization costs were compared between the two groups. Results There were no significant differences in length of stay, potassium concentration of postoperation and hemoglobin concentration of preoperation and postoperation between the two groups（P〉0.05）. Compared with group A, the surgery time was shorter, intraoperative blood loss was less, and recovery time of intestinal function was shorter in group B, but the hospitalization costs was higher, the differences were all statistically significant（P〈0.05）. Conclusion Compared with laparoscopic uterine resection combined with intraoperative uterine artery occlusion, preoperative use of small-dose Triptorelin has shorter surgery time, faster recovery of intestinal function, relatively smaller amount of bleeding,and is safer and more effective, so it is worthy of clinical application.