腹腔镜下子宫肌瘤剔除术与开腹子宫肌瘤切除术治疗效果及术后生育情况对比

Comparison of the therapeutic effect between the laparoscopic myomectomy and the transabdominal myomectomy for treating patients with fertility requirement

目的:分析有生育要求子宫肌瘤患者腹腔镜下子宫肌瘤剔除术与开腹子宫肌瘤切除术的治疗效果。方法:回顾性分析2019年1月-2021年1月在本院行开腹子宫肌瘤切除术(开腹组,n=82)和腹腔镜下子宫肌瘤剔除术(腹腔镜组,n=82)有生育要求子宫肌瘤患者的临床资料。比较两组手术疗效、手术治疗及术后并发症发生率,随访2年术后妊娠情况。结果:开腹组与腹腔镜组手术总有效率(93.0%、100.0%)无差异(P>0.05);腹腔镜组手术时间(72.7±11.5min)、术中出血量(85±16ml)、术后住院(8.7±1.3d)及疼痛消失时间(3.7±0.5d)均低于开腹组(85.1±12.4min、135±32ml、13.0±2.8d、7.8±2.1d),术后并发症总发生率(12.2%)低于开腹组(40.2%)(P<0.05),术后2年妊娠率腹腔镜组与开腹组(59.8%、45.1%)无差异,妊娠方式两组无差异(均P>0.05);腹腔镜组妊娠后流产(37.8%)及分娩剖宫产率(85.7%)均高于开腹组(16.2%、15.9%)(均P<0.05)。结论:对有生育要求的子宫肌瘤患者,腹腔镜下子宫肌瘤剔除术与开腹子宫肌瘤切除术临床疗效相当,但腹腔镜下子宫肌瘤剔除术围手术指标较好、术后并发症较少,开腹子宫肌瘤切除术术后妊娠结局相对较好。

Objective:To analyze the therapeutic effect of the laparoscopic myomectomy and the open myomectomy for treating patients with fertility requirements.Methods:The clinical data of the patients with uterine fibroids and fertility requirement who had undergone open myomectomy(82 cases in group A)or laparoscopic myomectomy(82 cases in group B)from January 2019 to January 2021 were analyzed retrospectively.The operative efficacy,the rates of intraoperative and postoperative complications,and the pregnancy situation within 2 years of follow-up after operatio of the patients were compared between the two groups.Results:There was no significant difference in the total effective rate(93.0%vs.100.0%)of the patients between the two groups(P>0.05).The operation time(72.7±11.5 min),the intraoperative blood loss(85±16ml),the duration of postoperative hospital stay(8.7±1.3d)and the pain disappearance time(3.7±0.5d)of the patients in group B were significantly lower than those(85.1±12.4 min,135±32ml,13.0±2.8d and 7.8±2.1d)of the patients in group A.The total incidence of postoperative complications(12.2%)of the patients in group B was significantly lower than that(40.2%)of the patients in group A(P<0.05).There was no significant difference in the pregnancy rate within 2-year(59.8%vs.45.1%)of the patients between the two groups,and there was no significant difference in the mode of pregnancy of the patients between the two groups(all P>0.05).The abortion rate after pregnancy(37.8%)and the cesarean section rate(85.7%)of the patients in group B were significantly higher than those(16.2%and 15.9%)of the patients in group A(all P<0.05).Conclusion:The therapeutic effect of the laparoscopic myomectomy and the open myomectomy for treating the patients with uterine fibroids and fertility requirements is similar.However,the laparoscopic myomectomy for treating patients with fertility requirements has better perioperative indicators and less postoperative complications,and the open hysteromyoma for treating patients with fertility requirements has relatively better pregnancy outcomes after operation.