经阴道子宫肌瘤剔除术治疗子宫肌瘤的可行性研究

Feasibility study of transvaginal myomectomy in the treatment of uterine myomas

目的分析子宫肌瘤剔除术的各种手术治疗方法,建立支持经阴道子宫肌瘤剔除术治疗子宫肌瘤的循证医学依据。方法选取2020年6月—2022年6月西安市人民医院因子宫肌瘤入院手术治疗且病理证实的患者327例,其中108例患者成功施行经阴道子宫肌瘤剔除术(观察组),同期行多孔腹腔镜子宫肌瘤剔除术的107例患者为对照组A,同期行单孔腹腔镜子宫肌瘤剔除术的112例患者为对照组B。记录患者术前、术中及术后相关临床数据及患者住院时间、术后并发症发生率。结果观察组剔除肌瘤个数(5.9±3.4)个,多于对照组A的(4.2±2.4)个及对照组B的(4.0±2.6)个,差异有统计学意义(P<0.05)。3组术中出血量相比,观察组[(98.1±58.7)ml]与对照组A[(97.4±54.1)ml]及对照组B[(96.2±56.2)ml]比较,差异无统计学意义(P>0.05)。观察组住院费用[(12354.3±934.1)元]少于对照组A[(15273.7±652.7)元]及对照组B[(15477.4±732.4)元],差异有统计学意义(P<0.05)。观察组手术时间[(77.3±13.2)min]短于对照组A[(94.8±21.2)min]及对照组B[(112.4±32.1)min],差异有统计学意义(P<0.05)。观察组住院时间[(6.2±2.9)d]与对照组A[(5.6±2.8)d]及对照组B[(5.9±3.2)d]比较,差异无统计学意义(P>0.05)。观察组术后排气时间[(19.4±5.3)h]短于对照组A[(28.6±8.1)h]及对照组B[(28.1±6.2)h],差异有统计学意义(P<0.05)。术后首次下床活动时间相比,观察组[(12.1±4.2)h]短于对照组A[(18.7±4.9)h]及对照组B[(19.2±4.1)h],差异有统计学意义(P<0.05)。结论经阴道子宫肌瘤剔除术用于子宫肌瘤的治疗,尤其针对子宫颈肌瘤或子宫下段肌瘤剔除是一项安全、有效、价格低廉的手术方式,适合在基层医院开展。

Objective To analyze various surgical treatment methods of hysteromyomectomy,and establish evidence-based medical evidence supporting transvaginal hysteromyomectomy for the treatment of hysteromyoma.Methods A total of 327 patients admitted to Xi'an People's Hospital from June 2020 to June 2022 for surgical treatment due to uterine fibroids and confirmed by pathology were selected,a⁃mong which 108 patients underwent transvaginal myomectomy successfully(observation group).Control group A included 107 patients who underwent perforated laparoscopic myomectomy,and control group B included 112 patients who underwent single-aperture laparoscopic myo⁃mectomy.The preoperative,intraoperative and postoperative clinical data,length of stay and incidence of postoperative complications were recorded.Results The number of fibroids removed in the observation group[(5.9±3.4)]was higher than that in the control group A[(4.2±2.4)]and in the control group B[(4.0±2.6)],and the difference was statistically significant(P<0.05).The intraoperative blood loss of the three groups was compared between the observation group[(98.1±58.7)ml]and the control group[(97.4±54.1)ml]and the control group B[(96.2±56.2)ml].The difference was not statistically significant(P>0.05).The hospitalization cost of obser⁃vation group[(12354.3±934.1)yuan]was less than that of control group A[(15273.7±652.7)yuan]and control group B[(15477.4±732.4)yuan],the difference was statistically significant(P<0.05).The operation time of the observation group[(77.3±13.2)min]was shorter than that of the control group A[(94.8±21.2)min]and control group B[(112.4±32.1)min],the difference was statistically significant(P<0.05).There was no significant difference in hospitalization time between the observation group[(6.2±2.9)days]and the control group A[(5.6±2.8)days]and the control group B[(5.9±3.2)days](P>0.05).The postopera⁃tive exhaust time in observation group[(19.4±5.3)h]was shorter than that in control group A[(28.6±8.1)h]and control group B[(28.1±6.2)h],and the difference was statistically significant(P<0.05).The first time of getting out of bed after operation in observa⁃tion group[(12.1±4.2)h]was shorter than that in control group A[(18.7±4.9)h]and control group B[(19.2±4.1)h],and the difference was statistically significant(P<0.05).Conclusion Transvaginal myomectomy is a safe,effective and inexpensive surgical method for the treatment of uterine myomas,especially for cervical myomas or myomas in the lower uterine segment,and it's suitable for pri⁃mary hospitals.