阴道超声引导腹腔镜下剔除多发性子宫肌瘤的术后效果

The effect of laparoscopic myomectomy guilded by transvaginal ultrasonography for treating women with multiple myoma

目的:分析多发性子宫肌瘤应用超声引导下腹腔镜剔除术,降低肌瘤残留及复发的效果。方法:选取2016年10月—2018年10月本院就诊的多发性子宫肌壁间肌瘤和浆膜下肌瘤患者,按随机数字原则分组,对照组行常规腹腔镜下多发性子宫肌瘤剔除术,观察组应用经阴道超声定位引导腹腔镜下行多发性子宫肌瘤剔除术。比较两组肌瘤残留及复发情况,分析肌瘤复发危险因素。结果:观察组手术时间(65.2±12.6min)大于对照组(59.8±12.7min)(P<0.05),两组术中出血量、术后排气时间、术后住院时间等无差异(P>0.05);观察组术后肌瘤残留发生率(4.3%)、残留肌瘤直径(0.58±0.19cm)及肌瘤复发率(5.7%)均小于对照组(14.3%、1.57±0.51 cm、17.1%)(P<0.05),术后肌瘤复发时间两组无差异(P>0.05)。肌瘤数量3~5个及术中无超声引导是子宫肌瘤术后复发的危险因素(P<0.05),而患者年龄、最大肌瘤直径与肌瘤复发无相关性(P>0.05)。结论:对多发性子宫肌瘤患者,辅助经阴道超声定位可降低腹腔镜下子宫肌瘤剔除术后肌瘤残留及复发风险。

Objective:To analyze the effect of laparoscopic myomectomy guilded by transvaginal ultrasonography for preventing the residue and recurrence of women with multiple myomata. Methods: The patients with multiple myomata multiple intramural myomyoma and subserosal myoma were selected and were divided into control group and observation group according to the random numbers table from October 2016 to October 2018. The patients in the control group were given conventional laparoscopic myomectomy, while the patients in the observation group were given laparoscopic myomectomy guilded by transvaginal ultrasonography. The situation of residual and recurrence of women between the two groups, and the risk factors of myomata recurrence were analyzed. Results: The operation time of patients in the observation group was 65.2±12.6 min, which was significant longer than that(59.8±12.7 min) of patients in the control group(P<0.05). There were no significant difference in intraoperative blood loss, postoperative exhaust time, and postoperative hospitalization time of patients between the two groups(P>0.05). The incidence of residual myomata after surgery, the the diameter of residual fibroids, and the recurrence rate of myomata of patients in the observation group were 4.3%, 0.58±0.19 cm, and 5.7%, which were significant lower than those(14.3%, 1.57± 0.51 cm, and 17.1%) in the control group(P<0.05). There was no significant difference in postoperative recurrence time between the two groups(P>0.05). The patients with 3-5 number of myomata and the operation without ultrasound guidance were the risk factors of postoperative recurrence of uterine myomata(P<0.05), while the age and maximum myomata diameter of patients were not correlated with the recurrence(P>0.05). Conclusion: The transvaginal ultrasonic location during laparoscopic myomectomy can reduce the risk of residual and recurrence of patients after operation.