腹式、阴式、腹腔镜子宫肌瘤剔除术的比较

A comparison of transabdominal,transvaginal and laparoscopic myomectomy

目的 评价腹式、阴式和腹腔镜下子宫肌瘤剔除术的优缺点。 方法 回顾分析腹式子宫肌瘤剔除术 89例 (腹式组 )、阴式子宫肌瘤剔除术 34例 (阴式组 )和腹腔镜下子宫肌瘤剔除术 6 2例 (腹腔镜组 )的临床资料。 结果 腹腔镜组手术时间为 (12 3 7± 5 6 7)min ,手术时间最长 ;腹式组次之 ,为 (90 5± 31 1)min ;阴式组手术时间最短 ,为 (6 0 7± 2 0 5 )min ;三组间差异有显著性 (P <0 0 5 ) ;腹腔镜组与腹式组之间术中失血量无统计学差异 (P >0 0 5 ) ,但明显多于阴式组 (P <0 0 5 ) ;腹腔镜组与阴式组之间剔除的肌瘤单个平均重量无统计学差异 (P >0 0 5 ) ,但明显轻于腹式组 (P <0 0 5 )。 结论 腹腔镜下子宫肌瘤剔除术与阴式子宫肌瘤剔除术都具有创伤小、恢复快、腹部无切口等优点 ,而腹式子宫肌瘤剔除术手术适应证更为广泛 ,剔除的肌瘤平均重量最重。

Objective To evaluate the advantages and disadvantages of transabdominal myomectomy (TAM), transvaginal myomectomy (TVM) and laparoscopic myomectomy (LM). Methods We retrospectively reviewed the clinical data of 89 cases of TAM (Group TAM), 34 cases of TVM (Group TVM) and 62 cases of LM (Group LM). Results About the operation time, the Group LM occupied the first place (123 7 min±56 7 min), the Group TAM came second (90 5 min±31 1 min), and the Group TVM last (60 7 min±20 5 min), with significant differences among the three groups ( P <0 01). There were no marked differences between the Group LM and the Group TAM in operative blood loss ( P >0 05), but the blood loss in both of the groups was much more than that in the Group TVM ( P <0 05). The mean weight of excised leiomyoma in the Group LM and the Group TVM had no significances between each other ( P >0 05), but markedly lower than that in the Group TAM ( P <0 05). Conclusions Both LM and TVM have advantages of micro invasion, rapid recovery and scarless abdomen. TAM has a great variety of indications and removes the lesions more thoroughly than the other two procedures.