腹腔镜子宫肌瘤切除术中子宫动脉预处理的方法和临床意义(附24例报告)  

Method and clinical significance of pretreatment of uterine arteries before laparoscopic myomectomy:with a report of 24 cases

作　　者：彭存旭[1] 汤玲[1] 兰守敏[2] 

机构地区：[1]济宁医学院附属医院,山东济宁272029 [2]山东省立医院

出　　处：《腹腔镜外科杂志》2007年第2期101-103,共3页Journal of Laparoscopic Surgery

摘　　要：目的：探讨腹腔镜子宫肌瘤切除术中子宫动脉预处理的必要性、方法及临床意义。方法：为42例浆膜下或肌壁间子宫肌瘤患者行腹腔镜子宫肌瘤切除术。24例先于腹腔镜下电凝阻断双侧子宫动脉，再行子宫肌瘤切除术。对照组18例未行腹腔镜下子宫动脉电凝阻断，直接行腹腔镜下子宫肌瘤切除术。结果：腹腔镜下子宫动脉阻断组23例成功实施了腹腔镜平滑肌瘤切除术，1例中转开腹。术中平均出血80ml。手术时间40～180min，平均90min。术后最高体温38．3℃，2d后恢复正常。对照组16例成功实施了腹腔镜肌瘤切除术，2例因术中出血较多中转开腹。术中平均出血180ml，手术时间50～210min，平均110min。两组术中出血量和手术时间差异有统计学意义（P〈0．05）。结论：腹腔镜下子宫动脉阻断后行子宫肌瘤切除术可明显减少术中出血，术野清晰，创面电凝少，明显减少了组织坏死，术后渗血少，并发症少，患者术后月经正常。Objective：To investigate the necessity, method, and clinical significance of pretreatment of uterine arteries before laparoscopic myomectomy. Methods：Forty-two cases with intramural or pedunculated subserosal uterine leiomyomas underwent laparoscopic myomectomy. 24 cases underwent uterine artery occluded by electrocoagulation before laparoscopic myomectomy while the other 18 cases as control group underwent laparoscopic myomectomy only. Results： Twenty-three cases in uterine artery electrocoagulation group underwent laparoscopic myomectomy successfully while only one case converted to laparotomy because of bleeding. The mean volume of bleeding was 80ml. The surgery lasted 40-180min （ the mean 90min）. The highest temperature after surgery was 38.30℃ and fell to normal two days later. 16 cases in control group underwent laparoscopic myomectomy successfully while two cases converted to laparotomy because of bleeding. The mean volume of bleeding was 180ml. The surgery lasted 50-210min （the mean 110min）. The differences of blood loss and operating time between the two groups were significant（ P 〈 0. 05 ）. Conclusions：Uterine artery electrocoagulation before laparoscopic myomectomy can reduce blood loss thus make the surgical field clean and clear. It can also reduce electrocoagulation on the surgical surface and therefore cause less tissue necrosis. This causes less blood seepage and lower incidence of complications, and the patients have normal menstrual cycle after the operation.

关 键 词：子宫肿瘤 腹腔镜术 子宫动脉阻断 预处理 电凝术 

分 类 号：R737.33[医药卫生—肿瘤]