腹腔镜下两种子宫动脉阻断法对子宫肌瘤剔除术的应用价值  

Investigation on laparoscopic myomectomy combined with tentative uterine artery blockage

作　　者：孙茹[1] 朱剑飞[1] 刘海燕[1] 

机构地区：[1]扬州市第一人民医院妇产科,225002

出　　处：《中华腔镜外科杂志（电子版）》2017年第1期50-52,共3页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的探讨腹腔镜下子宫肌瘤剔除术中子宫动脉暂时阻断法的不同术式的效果。方法选择扬州市第一人民医院2014年1月至2015年12月因子宫肌瘤入院,行腹腔镜下子宫肌瘤剔除术的148例患者为研究对象,年龄33~45岁,平均37.4岁,均既往体健。将患者随机分为两组:对照组为子宫动脉结扎阻断法,即术中腹腔镜下于子宫旁约5 cm、骶韧带根部外侧2~3 cm的侧腹膜打开,找到子宫动脉,游离并丝线活结结扎,阻断其血供;观察组为子宫动脉止血带阻断法,即术中在子宫峡部水平,止血带环绕并外科结结扎1次或2次,再进行肌瘤剔除。比较两组的术中出血量、手术时间、盆腔腹膜缺损、住院时间、术后排气时间、术中并发症等的差异。结果两组的术中出血量相比,无明显差异(t=0.584,P=0.560);两组的手术时间(t=7.603、P=0.000),盆腔腹膜缺损(χ~2=4.812、P=0.028),住院时间(t=3.824、P=0.000),术后排气时间(t=98.140、P=0.000),术中并发症率(χ~2=6.009、P=0.014)比较,对照组较观察组明显增加。结论腹腔镜下子宫肌瘤剔除术中,通过止血带阻断法暂时阻断子宫动脉血供,能有效减少术中出血,且简单易行,并发症少、损伤小、粘连少,有一定的推广价值。Objective To compare surgical outcomes of laparoscopic myomectomy combined with uterine artery blockage by different surgical procedures in patients with uterine fibroids. Methods Clinical data of 148 patients with uterine fibroids undergoing laparoscopic myomectomy treatments in our hospital from Jan. 2014 to Dec. 2015 were retrospectively analyzed. All these patients were in health before, averaged 37.4 years old ranging between 33 and 45. The patients enrolled were divided into two groups： In control group, the uterine artery was often isolated at the 2 -3 cm laterally to uterosacral ligaments in lateral edge 5 cm to uterus under direct visualization with the laparoscope. Subsequently, the majority of these uterine arteries could be separated clearly and then be tied off with reef knot to stop blood supply. In treatment group, the uterine artery at the level of isthmus uteri was tied off with one or two surgical knots and an additional tourniquet was applied. Average blood loss, pelvic peritone uterinemyoma defects, operative difficulties; average operative time, postoperative complications of the two groups were compared. Results The average operative time （ t = 7. 603, P = 0. 000）, pelvic peritone uterinemyoma defects （χ2 = 4. 812, P = 0. 028 ）, length of stay （ t = 3. 824, P = 0. 000 ）, exhaust time （ t = 98. 140, P = 0. 000 ） and postoperative complications（χ2 = 6. 009,P = 0. 014） were increased in group control than that in treatment group. However, there was no statistically significant difference for average blood loss （t = 0. 584, P = 0. 560） between the two groups. Conclusion In laparoscopic myomectomy, uterine artery blockage with tourniquet using cervical cerclage had a good effect in treatment of uterine fibroids with less perioperative bleeding, reduced damage, low rate of complications and adhesions. It was simple and practicable and was worth of spreading in clinical practice.

关 键 词：腹腔镜手术 子宫肌瘤 子宫动脉阻断 并发症 

分 类 号：R737.33[医药卫生—肿瘤]