多途径超声监测腹腔镜子宫肌瘤剔除术的价值研究  

Clinical value of multipath ultrasonography monitoring during laparoscopic myomectomy

作　　者：曹佃霞 陈雨龙[2] 刘素丽[2] 宋克娟[2] 刁玉超 戴淑真[2] 姚勤[2] 

机构地区：[1]青岛大学,青岛266071 [2]青岛大学附属医院妇科,青岛266550

出　　处：《现代妇产科进展》2017年第10期731-734,738,共5页Progress in Obstetrics and Gynecology

摘　　要：目的:探讨在腹腔镜子宫肌瘤剔除术围手术期,多途径超声动态监测的临床价值。方法:行腹腔镜下子宫肌瘤剔除术的患者169例,围手术期应用腹部、阴道或直肠超声以及腹腔内超声动态监测。术前,腹部超声、阴道超声可评估子宫肌瘤的特征。术中应用多途径超声监测肌瘤位置、指引剔除。应用阴道超声评估肌瘤残留情况。结果:169例腹腔镜子宫肌瘤剔除术患者中,共剔除肌瘤721枚,其中非超声引导剔除肌瘤431枚,超声引导多剔除肌瘤282枚,术中结合宫腔镜剔除肌瘤8枚。超声引导下避免穿透子宫内膜患者37例,发现肌瘤部位血肿3例,发现盆腔隐匿病灶5例。应用"挑出法"剔除子宫肌瘤156枚,占肌瘤切除总数的21.63%。结论:腹腔镜下子宫肌瘤剔除术围手术期,应用多途径超声动态监测,可有效减少肌瘤残留,判断肌瘤的剔除方式,避免术中损伤子宫内膜,及时发现血肿病灶,减少围手术期并发症。"挑出法"是超声引导剔除3型、4型小肌瘤的有效方法。Objective： To evaluate the clinical value of multiple pathways ultrasonography during laparoscopic myomectomy perioperative period. Methods： A total of 169 women,received laparoscopic myomectomy,were examined by multiple pathways ultrasonography,including abdominal,transvaginal,transrectal ultrasonography and laparoscopic ultrasound（LUS）,during the perioperative stage.Firstly,before the operation,abdominal ultrasonography and transvaginal ultrasonography were used to evaluate the fibroids characteristic. Intraoperatively,ultrasonography could monitor the location of fibroids and help operators find them to remove them.Lastly,transvaginal ultrasonography was used to evaluate the residual fibroids situation.Results：Among the 169 cases,we removed 721 fibroids in all,431 fibroids among which were removed without ultrasonography,while the other 282 fibroids were removed depending on ultrasonography assistance,8 fibroids depending on hysteroscopy.37 cases avoided hurting their endometrium under the guide of the ultrasonography.Intraoperative ultrasonography detected hematoma in3 women and pelvic hidden lesions in 5 cases.Thanks to the ＂pick up way＂that removed 156 uterine fibroids,which was accounting for 21.63% of the removed fibroids.Conclusions： Dynamic multipath ultrasonography is used during the laparoscopic myomectomy perioperative period,which can judge the fibroids excision ways,reduce the residual fibroids and the risk of intraoperative endometrial injury,discover the hematoma timely,reduce the perioperative complications.The way of ＂ pick up way＂ is the effective method to eliminate style 3 or 4 fibroids with the guidance of ultrasonography.

关 键 词：子宫肌瘤 超声检查 腹腔镜子宫肌瘤剔除术 

分 类 号：R737.33[医药卫生—肿瘤]