开腹与腹腔镜下子宫肌瘤剔除术的对比研究  

Comparative study of transabdominal and laparoscopic myomectomy

作　　者：李艺平 颜友良[2] 王秀中 钟亮尹[3] 钟洁[4] 

机构地区：[1]广东省中山市东升医院妇产科,528412 [2]广东省中山市博爱医院妇产科,528400 [3]广东药学院附属第一医院检验科,广州510080 [4]上海市杨浦区市东医院妇科,200430

出　　处：《中华妇幼临床医学杂志（电子版）》2017年第1期61-64,共4页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：广东省医学科学技术研究基金项目(2015120124650789)~~

摘　　要：目的探讨开腹与腹腔镜下子宫肌瘤(UM)剔除术后患者肌瘤残留、复发及妊娠结局。方法选取2009年1月至2015年12月,于广东省中山市东升医院妇产科收治的116例UM患者为研究对象。根据随机数字表法,将其分为观察组(n=58)与对照组(n=58)。对观察组患者进行腹腔镜下UM剔除术,对照组患者进行常规开腹UM剔除术。统计学比较2组UM患者的术中出血量、手术时间、住院时间,剔除的UM个数、重量,术后并发症发生情况,以及术后患者妊娠结局、UM残留及复发情况。2组患者年龄、UM直径、个数及单发与多发性UM构成比等一般临床资料比较,差异均无统计学意义(P>0.05)。本研究与所有同意接受研究的UM患者签署知情同意书。结果 1与对照组相比,观察组UM患者术中出血量、剔除的UM个数均显著减少,手术时间、住院时间均显著缩短,剔除的UM重量显著降低,并且差异均有统计学意义(t=7.136,P=0.029;t=4.913,P=0.041;t=9.259,P=0.017;t=5.715,P=0.035;t=8.149,P=0.023)。2观察组UM患者术后并发症发生率为15.5%(9/58),显著低于对照组的27.7%(16/58),二者比较,差异有统计学意义(χ~2=4.132,P=0.045)。32组UM患者术后UM残留率、复发率及妊娠率分别比较,差异均无统计学意义(χ~2=0.892,P=0.345;χ~2=1.335,P=0.248;χ~2=0.637,P=0.425)。结论开腹与腹腔镜下UM剔除术后,UM残留、复发及妊娠结局相近,但腹腔镜下UM剔除术手术时间、住院时间、术中出血量等方面,优于开腹UM剔除术,并且术后并发症少,安全性高。Objective To explore the residual, recurrence and pregnancy outcomes of uterus myoma （UM） patients with transabdominal and laparoscopic myomectomy. Methods From January 2009 to December 2015, a total of 116 cases of UM patients in Department of Obstetrics and Gynecology, Zhongshan Dongsheng Hospital of Guangdong Province were selected as research objects. According to the random number table method, they were divided into the observation group （n= 58） and control group （n=58）. The patients in observation group were treated with laparoscopic myomectomy, and the patients in control group underwent routine laparotomy myomectomy. The transoperative bleeding volume, operation duration, length of hospitalization, removal number ofUM, removal weight of UM, postoperative complications, and postoperative pregnancy outcomes, UM recurrence and residual between two groups were analyzed by statistical methods. There were no significant differences between two groups in the age, diameter and number of UM and constituent ratio of solitary and multiple UM （P〉0. 05）. All the UM patients who agreed to accept this study signed the informed consent. Results ① Compared with control group, both the transoperative bleeding volume and removal number of UM in the observation group were significantly reduced, and both the operation duration and length of hospitalization were significantly shortened, and removal weight of UM decreased significantly, and all the differences were statistically significant （t= 7. 136, P=0.029; t=4. 913, P=0.041; t=9. 259, P=0.017; t=5. 715, P=0.035; t=8. 149, P= 0. 023）. ②The incidence of postoperative complication in observation group was 15. 5% （9/58）, which was significantly lower than 27. 7% （16/58） in control group, and the difference was statistically significant （χ2= 4. 132, P= 0. 045）. ③There were no significant differences between two groups in the rates of UM residual, UM recurrence and pregnancy （χ2 =0. 892, P=0. 345; χ2 = 1. 335, P=0. 248; χ2 =0. 637,

关 键 词：平滑肌瘤 肿瘤 残余 肿瘤复发 局部 妊娠结局 开腹子宫肌瘤剔除术 腹腔镜下子宫肌瘤剔除术 妇女 

分 类 号：R737.33[医药卫生—肿瘤]