子宫肌瘤腹腔镜剥除术中应用子宫峡部套扎联合小剂量垂体后叶素分次注射效果

Effect of uterine isthmus ligation combined with low dose vasopressin by fractional injection of patients during laparoscopic excision of hysteromyoma

目的:观察子宫峡部套扎联合垂体后叶素小剂量分次注射在子宫肌瘤腹腔镜剥除术中应用效果及对患者微循环指标的影响。方法:选取2019年1月-2022年5月本院拟行子宫肌瘤腹腔镜剥除术患者66例,以随机单盲抽签法分为观察组和对照组各33例,均行腹腔镜剥除术,术中对照组予以传统缝合止血联合一次性注射垂体后叶素、观察组予以子宫峡部套扎联合垂体后叶素小剂量分次注射。比较两组止血疗效、手术情况、用药前后舒张压(DBP)、收缩压(SBP)、心率(HR)变化、并发症情况,治疗后随访3个月统计两组月经情况。结果:观察组术中出血量(52.6±7.9ml)、术后肛门排气(1.6±0.6d)及住院(4.7±1.1d)时间均少于对照组(74.3±9.6ml、2.1±0.7d、6.0±1.3d);两组用药15 min后DBP、SBP、HR水平均较用药前提高但观察组(74.3±5.4 mmHg、110.3±9.1 mmHg、75.5±4.6次/min)均低于对照组(78.0±6.1 mmHg、117.0±10.0 mmHg、80.9±5.3次/min)(P<0.05);观察组止血总有效率(97.0%)高于对照组(75.8%)(均P<0.05)。两组术后并发症发生率(18.2%、24.2%)无差异(P>0.05);两组治疗后3个月月经量、月经期均较治疗前降低,且观察组(46.1±2.2ml、4.7±1.3d)低于对照组(52.7±3.1ml、6.3±1.4d)(P<0.05)。结论:子宫肌瘤腹腔镜剥除术中应用子宫峡部套扎联合垂体后叶素小剂量分次注射可提高止血效果,利于手术进行,促进患者术后恢复。

Objective: To observe the application effect of isthmus ligation combined with low-dose vasopressin by fractional injection of patients during laparoscopic excision of hysteromyoma, and to study its influence on the microcirculation of these patients. Methods: From January 2019-May 2022, 66 patients with laparoscopic excision of uterine fibroids were selected and were divided into two groups(33 cases in each group) by random single-blind drawing. The patients in the control group received traditional suture hemostasis combined with pituitary by one-time injection during the operation, and the patients in the observation group received uterine isthmus ligation combined with low-dose vasopressin by fractional injection during operation. The hemostatic efficacy, the surgical conditions, the changes of microcirculation indexes, such as diastolic blood pressure(DBP), systolic blood pressure(SBP), and heart rate(HR) before and after treatment, and the complications situation of the patients were compared between the two groups. 3 months of follow-up after treatment, the menstrual situation of the patients in the two groups were counted. Results: The intraoperative blood loss(52.6±7.9ml), the postoperative anal exhaust time(1.6±0.6d), and the hospitalization stay(4.7±1.1d) of the patients in the observation group were significantly shorter than those(74.3±9.6ml, 2.1±0.7d, and 6.0±1.3d) of the patients in the control group. The values of DBP, SBP, and HR of the patients in both groups after 15 min of treatment had increased significantly, and which(74.3±5.4 mmHg, 110.3±9.1 mmHg, and 75.5±4.6 times/min) of the patients in the observation group were significantly lower than those(78.0±6.1 mmHg, 117.0±10.0) mmHg, and (80.9±5.3 times/min) of the patients in the control group(P<0.05). The total effective rate of hemostasis(97.0%)of the patients in the observation group was significantly higher than that(75.8%)of the patients in the control group(all P<0.05).There was no significant difference in the incidence of postoperative complications(18.2% vs.24.2%)of the patients between the two groups(P>0.05).3months after treatment,the menstrual volume and menstrual period of the patients in both groups had decreased significantly,and which(46.1±2.2ml and 4.7±1.3d)of the patients in the observation group were significantly lower than those(52.7±3.1ml and 6.3±1.4d)of the patients in the control group(P<0.05).Conclusion:The application of isthmus ligation combined with low-dose vasopressin by fractional injection of the patients during laparoscopic excision of uterine fibroids improves their hemostasis effect,is beneficial to the operation,promotes the recovery of the patients,and has less impact on the microcirculation system of the patients.