改良腹壁悬吊式无气腹腹腔镜技术在子宫肌瘤剔除术中应用研究

Clinical study of modified abdominal walllift technique in gasless laparoscopic uterine myomectomy

目的探讨改良腹壁悬吊式无气腹腹腔镜技术在子宫肌瘤剔除术中应用的可行性及优势。方法选择2017年12月至2018年12月呼和浩特市第一医院妇产科收治的有手术指征的100例子宫肌瘤患者,随机分为两组,分别应用改良腹壁悬吊式无气腹腹腔镜技术剔除子宫肌瘤(改良组,50例)和传统腹壁悬吊式无气腹腹腔镜技术剔除子宫肌瘤(传统组,50例)。对两组患者的手术时间、出血量、肌瘤剔除平均时间、术后肠功能恢复时间和术后住院时间等进行比较。结果改良组手术时间[(72.3±35.6)min]、出血量[(204.9±167.3)mL]均显著短于和小于传统组[(82.7±31.9)min和(266.7±190.5)mL](均P<0.05);改良组单个肌瘤剔除时间[(16.5±6.8)min]、直径<6.5 cm的肌瘤剔除时间[(17.4±4.7)min]和直径≥6.5 cm的肌瘤剔除时间[(21.6±9.3)min]均短于传统组[(24.4±10.7)min、(23.2±11.4)min和(27.2±13.2)min](均P<0.05);两组在术后肠功能恢复时间和术后住院时间方面差异均无统计学意义[分别为(18.4±6.9)h、(4.2±0.8)d和(16.6±7.3)h、(4.0±0.6)d](均P>0.05)。结论改良腹壁悬吊装置无需再安装悬吊棒,改善了术者在腹腔外的手术操作空间,方便了手术操作,使悬吊式腹腔镜手术操作更加简单易行、经济实用,具有一定的临床应用价值,有必要进一步探讨和应用。

Objective To investigate the feasibility and clinical value of modified abdominal wall lift laparoscopic technique in uterine myomectomy.Methods Totally 100 patients of uterine fibroids with surgical indications were selected and divided into two groups randomly,modified group(50 cases) and traditional group(50 cases).The former was treated by modified abdominal wall lift laparoscopic technique and the latter by traditional abdominal wall lift laparoscopic technique to remove uterine fibroids,and the operation time,intraoperative blood loss,the time of single myoma removal,postoperative intestinal function recovery and postoperative hospital stay were compared between the two groups.Results The operation time and intraoperative blood loss were significantly lower in modified group [(72.3±35.6) min、(204.9±167.3) mL] than in traditional group [(82.7±31.9) min,(266.7±190.5) mL](P<0.05),and the removal times of single myoma,diameter<6.5 cm and diameter≥6.5 cm in modified group[(16.5±6.8)min,(17.4±4.7)min and(21.6±9.3)min] were significantly lower than that in traditional group [(24.4±10.7) min,(23.2±11.4) min and(27.2±13.2) min](P<0.05).There was no significant difference in postoperative intestinal function recovery time and postoperative hospital stay between the two groups(18.4±6.9)h,(4.2±0.8)d an d(16.6±7.3)h,(4.0±0.6)d,respectively](P>0.05).Conclusion The modified,which improves the operation space of the surgeon outside the abdominal cavity,facilitates the surgical procedures,and makes the laparoscopic surgery easier and more practical.