腹腔镜下和经腹子宫肌瘤剔除术的临床比较  

A comparison study of laparoscopic and abdominal myomectomy

作　　者：白文佩[1] 穆兰芳 周应芳[1] 李克敏[1] 林怀宪[1] 秦小琪[3] 

机构地区：[1]北京大学第一医院妇产科,北京100034 [2]青海省妇女儿童医院,青海西宁810007 [3]北京大学第一医院医学统计室,北京100034

出　　处：《中国内镜杂志》2007年第9期903-905,共3页China Journal of Endoscopy

摘　　要：目的比较腹腔镜下子宫肌瘤剔除术和经腹子宫肌瘤剔除术的临床效果。方法收集经腹腔镜或开腹剔除肌瘤、最大肌瘤直径小于8cm的患者资料,其中腹腔镜组82例,开腹组78例,比较其手术前、手术中、手术后的情况,并进行随访。结果两组手术时间、剔除肌瘤总重量、剔除肌瘤个数差异无显著性;比较两组术中出血、最大肌瘤位于子宫后壁[腹腔镜组13.41%(11例)vs开腹组23.08%(18例)]、术后发热[腹腔镜组21.95%(18例)vs开腹组48.72%(38例)]、术后使用止痛剂[腹腔镜组41.46%(34例)vs开腹组67.95%(53例)]、住院时间[腹腔镜组(7.14±1.67)dvs开腹组(10.25±2.76)d]、生活恢复自理时间[腹腔镜组(5.45±2.82)dvs开腹组(10.61±5.27)d]和重返工作岗位时间[腹腔镜组(28.25±11.18)dvs开腹组(39.12±13.25)d],腹腔镜组均低于开腹组,差异有统计学意义。腹腔镜中转开腹比例为2.44%(2例)。2年(0.5～5.0年)的随访提示两组间复发率和妊娠率相似,复发率腹腔镜组2.44%(2例)、开腹组3.85%(3例),妊娠率腹腔镜组6.10%(5例)、开腹组5.13%(4例),无瘢痕破裂病例。结论对于子宫肌瘤最大直径小于8cm的病例,经腹腔镜剔除是安全有效的,具有术中出血少、术后疼痛少、恢复快的优势。[Objective] To determine the differences in practice between laparoscopic myomectomy（LM） and abdominal myomectomy（AM）. [Method] We analyzed data for 82 LMs and 78 Ams performed from Jan 2000 to Jan 2005 in the 1st hospital of Peking University. The largest diameter of myoma must be lower than 8cm. Compared the pre-, per- and post-operative instances. [Result] The operative time, the total weight and number of myoma were similar in the two groups. Compared with AM, LM had less bleeding, lower ratio of the largest myoma located in posterior uterine [13.41%（11cases） vs AM 23.08%（18 cases）], less advent of fever post operation [21.95%（18 cases） vs AM 48.72%（38 cases）], less rate to use analgetic [41.46%（34 cases） vs AM 67.95%（53 cases）], shorter hospital time（7.14±1.67） days vs AM （10.25±2.76） days, shorter length of specially attending demand（5.45±2.82） days vs AM （10.61±5.2/） days and quicker comeback to work（28.25±11.18） days vs AM （39.12±13.25） days, and all the differences had statistic signitieanee. The conversion rate of LM to AM was 2.44%（2 eases） due to heavy pelvic adhesion. After 2 （0.5 -5） years follow-up, the recurrence and pregnancy rates were similar, the recurrence rate for LMs was 2.44%（2 cases）vs AMs 3.85%（3 cases） and pregnancy rate for LMs was 6.1%（5 cases） vs AMs 5.13%（4 cases）, no scar rupture occurred in these pregnancies. [Conclusion] LM has the advantage of a minimally invasive operation, and it＇s safe and effective for diameter less than 8 em myoma.

关 键 词：肌瘤剔除术 经腹 腹腔镜 子宫肿瘤 子宫手术 

分 类 号：R737.33[医药卫生—肿瘤]