探讨阴式子宫肌瘤剥除术在妇科微创手术中的临床应用及影响术中出血量的因素

To explore the clinical application of vaginal uterine fibroids removal in gynecological minimally invasive surgery and the factors affecting intraoperative blood loss

目的:探讨子宫肌瘤患者采用阴式子宫肌瘤剥除术治疗的临床效果,并分析影响术中出血量的因素。方法:回顾性分析在医院行子宫肌瘤剥除术的78例患者的临床资料,根据手术方式分为两组,分别为阴式组和腹腔镜组,每组各39例,阴式组给予阴式子宫肌瘤剥除术治疗,腹腔镜组给予腹腔镜子宫肌瘤剥除术治疗。对比两组临床治疗效果、术中术后各项指标情况,并对影响阴式子宫肌瘤剥除术术中出血量的因素进行分析。结果:阴式组手术时间、术中出血量、肛门排气时间、术后镇痛率、住院时间、住院费用均少于腹腔镜组,差异均有统计学意义(P<0.05);阴式组、腹腔镜组总有效率分别为97.44%、82.05%,阴式组有效率显著高于腹腔镜组,差异有统计学意义(P<0.05);通过对阴式子宫肌瘤剥除术术中出血量的影响因素进行分析,结果显示,多发肌瘤的术中出血量高于单发肌瘤,肌瘤直径≥6 cm的术中出血量高于肌瘤直径<6 cm的术中出血量,壁间深部的术中出血量高于前壁、后壁,差异有统计学意义(P<0.05),提示肌瘤数目、直径、部位是影响阴式子宫肌瘤剥除术术中出血量的因素。结论:阴式子宫肌瘤剥除术是治疗子宫肌瘤安全经济有效的微创术式,其具有创伤小、术后疼痛轻、恢复快、无瘢痕等优点,术中出血量受到肿瘤大小、数量及部位的影响。

Objective To investigate the clinical effects of uterine fibroids removal in patients with uterine fibroids and to analyze the factors affecting intraoperative blood loss.Method The clinical data of 78 patients who underwent uterine fibroids removal in the hospital were retrospectively analyzed.The patients were divided into two groups according to the surgical procedure:the vaginal group and the laparoscopic group.39 cases in each group,the vaginal group was treated with vaginal uterine fibroids removal,and the laparoscopic group was treated with laparoscopic uterine fibroids.The clinical effects of the two groups,the indexes of the intraoperative and postoperative indexes were compared,and the factors affecting the amount of bleeding during the vaginal uterine fibroids removal were analyzed.Results The operation time,intraoperative blood loss,anal exhaust time,postoperative analgesia rate,hospitalization time,and hospitalization cost were lower in the vaginal group than in the laparoscopic group.the difference was statistically significant(P<0.05);The total effective rate of the vaginal group and the laparoscopic group were 97.44%and 82.05%,respectively.The vaginal group was significantly higher than the laparoscopic group,and the difference was statistically significant(P<0.05).The intraoperative bleeding was performed by vaginal uterine fibroids.The influencing factors of the amount were analyzed.The results showed that the intraoperative blood loss of multiple fibroids was higher than that of single fibroids.The intraoperative blood loss of fibroids≥6 cm was higher than<6 cm,and the intraoperative blood loss was higher than the depth between the walls.The difference between the anterior and posterior wall was statistically significant(P<0.05),suggesting that the number,diameter and location of fibroids were the factors affecting the amount of bleeding during the removal of uterine fibroids.Conclusion The vaginal uterine fibroids removal is a safe and effective minimally invasive procedure for the treatment of uterine fibroids.It has the advantages of small trauma,light postoperative pain,rapid recovery,no scar,etc.The amount of intraoperative blood loss is affected by tumor size and quantity.And the impact of the site.