超声止血刀在腹腔镜子宫肌瘤挖除术中的应用

The role of laparoscopic ultrasonic scalpel in myomectomy:a analysis of 82 cases

目的 探讨超声止血刀在子宫肌瘤挖除术中的切割、止血的效果。方法 2 0 0 1年 8月～ 2 0 0 3年 6月期间 ,对 82例有症状且要求保留子宫的子宫肌瘤患者采用腹腔镜下 1 0mm超声止血刀进行子宫肌瘤挖除术治疗。结果 所有病例均在腹腔镜下采用超声止血刀完成手术 ,本组病例大部分为多发子宫肌瘤患者 ,其中肌壁间肌瘤 4 9例 ,浆膜下肌瘤 33例 ,数目 1～ 6个 ,肌瘤直径大小 2～ 1 5cm ,6 6例子宫切口进行了缝合。平均手术时间为 (1 0 9.2± 35 .4 )min ,估计平均失血量为 (1 2 1 .8± 4 7.3)ml,病人平均住院日为 (5 .2± 1 .5 )d。所有病例腹腔镜手术均成功 ,无手术并发症。随访 2～ 2 2个月 ,所有有症状者术后均改善 ,无 1例复发和手术后并发症。结论 腹腔镜下采用超声止血刀切割和止血具有手术时间短 ,止血效果更佳 。

Objective To investigate effects of the laparoscopic ultrasonic scalpel and shears on hemostasis in the laparoscopic myomectomy in treating symptomatic fibroids.Method Eighty two women with symptomatic fibroids warranting surgical treatment and wanting to retain their uteri were treated by laparoscopic myomectomy using a 10 mm ultrasonic scalpel and shears.Result Most of 82 patients had multi myoma of uterus,which located in intramural fibroids (49) and subserous fibroids (33).The number of fibroids of each patient varied from 1 to 6.The size of myomas in all patients ranged from 15 to 2 cm.In 66 cases (64.3%) the uterine wall was sutured in one layer.Average operating time was (109.2±35.4)min and average blood loss was (121.8±47.3)ml respectively.Mean postoperative hospital stay was (5.2±1.5)days.All patients underwent technically successful laparoscopic myomectomy without intraoperative complications.The mean follow up time was 13.6 months (2 22).Symptomatic improvement was achieved in all patients.There was no recurrence of fibroid.Conclusion Using ultrasonic scalpel and shears on hemostasis in laparoscopic myomectomy appears to be a safe,effective,and promising new method for treating symptomatic uterine leiomyomata.