腹腔镜超声在腹腔镜子宫肌瘤剔除术中的应用价值  

Clinical Value of Laparoscopic Ultrasonography in Laparoscopic Myomectomy

作　　者：郝焰[1] 吴青青[2] 卢丹[1] 郑萍[1] 吴霞[1] 周琦[1] 盛洁[1] 魏薇[1] 段爱红[1] 李慧[1] 李斯静[2] 

机构地区：[1]首都医科大学附属北京妇产医院妇科,北京100026 [2]首都医科大学附属北京妇产医院超声医学科,北京100026

出　　处：《中国微创外科杂志》2017年第6期483-486,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：首都医科大学附属北京妇产医院中青年学科骨干培养项目(fcyy201519)

摘　　要：目的探讨腹腔镜超声在腹腔镜子宫肌瘤剔除术中的应用价值。方法选择2014年12月~2016年2月子宫肌瘤剔除术,肌瘤数目≤5个,肌壁间肌瘤直径≤6 cm,浆膜下肌瘤直径≤10 cm,按术者不同分为腹腔镜超声组(研究组)及腹腔镜组(对照组),最终完成随访研究组86例,对照组96例。2组均行腹腔镜手术,尽可能剔除肌瘤,研究组经腹腔镜超声探查,发现的肌层残留肌瘤尽量剔除。术后3、6、9、12个月行阴道超声检查:术后3个月B超提示子宫肌瘤,定义为子宫肌瘤剔除术后残留;术后3个月B超提示正常,术后6个月或之后B超提示子宫肌瘤,定义为子宫肌瘤剔除术后复发。结果研究组剔除可视及器械可探及的不可视肌瘤后,经腹腔镜超声发现存在残留肌瘤37例(43.0%),共80枚,剔除肌瘤58枚。研究组剔除肌瘤明显多于对照组[中位数4枚vs.2.5枚,Z=-2.413,P=0.016]。研究组残留率和复发率均明显低于对照组[残留率23.3%(20/86)vs.39.6%(38/96),χ~2=5.570,P=0.018;复发率11.6%(10/86)vs.27.1%(26/96),χ~2=6.829,P=0.009]。结论腹腔镜超声应用于腹腔镜下子宫肌瘤剔除术,可有效、安全地减少术后肌瘤残留及复发。Objective To evaluate the clinical value of laparoscopic ultrasonography in laparoscopic myomectomy surgery. Methods Patients planned for myomectomy from December 2014 to February 2016, with myomas less or equal to 5, or intramural myoma with a diameter less or equal to 6 cm, or subserosa myoma with a diameter less or equal to 10 cm, were divided into study group （ n = 86） and control group （ n = 96） according to different surgeons. All the patients had undergone laparoscopic myomectomy. During operation the surgeons enucleated as many myomas as possible. Then laparoscopic uhrasonography was used in study group to search uterus for remaining myomas in muscular layer and enucleated when possible. Post-surgery follow-ups with transvaginal uhrasonography were conducted at 3, 6, 9, and 12 months. If B-uhrasonography indicated uterine myoma within 3 months, it was considered as residual of myomectomy; if uhrasonography within 3 months after surgery was negative and indicated uterine myomas within 6 months, it was considered as recurrence. Results When excluding myomas which were visible or invisible but palpable by equipment, 80 myomas in 37 patients （43.0%） were discovered by laparoscopic ultrasonography in the study group. The number of enucleated myomas was more than the control group [ median, 4 vs. 2.5, Z = - 2. 413, P = 0. 016 1. The residual rate and recurrence rate of study group were significantly lower than the control group [ residual rate： 23.3% （20/86） vs. 39.6% （38/96） , χ^2 = 5. 570, P = 0. 018; recurrence rate： 11. 6% （ 10/86 ） vs. 27. 1% （26/96） ,χ^2= 6. 829, P = 0. 009 ]. Conclusion Laparoscopic uhrasonography in laparoseopic myomeetomy can safely and effectively reduce the residual rate and recurrence rate of myomas after surgery.

关 键 词：腹腔镜超声 腹腔镜 子宫肌瘤 残留 复发 

分 类 号：R737.33[医药卫生—肿瘤]