经脐手术刀肌瘤分碎术与电动肌瘤分碎术在腹腔镜子宫肌瘤剔除术中应用的比较  

A Comparative Study of Transumbilical Scalpel Morcellation and Electric Power Morcellation in Laparoscopic Myomectomy

作　　者：刘艳丽 郭亮生[2] 张思佳 戴淑榕 孙白云 任琼珍[2] 陶晓敏[2] 朱维培[2] Liu Yanli;Guo Liangsheng;Zhang Sijia(Department of Obstetrics and Gynecology, Second Affiliated Hospital of Soochow University, Suzhou 215004, China)

机构地区：[1]核工业四一七医院苏州大学附属第二医院西安分院妇产科,西安710600 [2]苏州大学附属第二医院妇产科,苏州215004

出　　处：《中国微创外科杂志》2021年第10期912-917,共6页Chinese Journal of Minimally Invasive Surgery

基　　金：江苏省卫生健康委员会科研项目(QNRC2016881,F201922);苏州市科技计划项目(SYSD2019106,SYS2020134);苏州市卫生健康委员会科研项目(GSWS2020028)。

摘　　要：目的比较腹腔镜子宫肌瘤剔除术中经脐手术刀肌瘤分碎术与传统电动肌瘤分碎术的效果。方法2014年1月~2019年12月120例腹腔镜子宫肌瘤剔除术,其中60例采用经脐手术刀肌瘤分碎术(观察组),60例采用电动肌瘤分碎术(对照组),比较2组患者腹盆腔及切口肌瘤组织碎片残留数量、手术时间、标本取出时间、术中出血量、术后24和48 h疼痛数字评分(Numeric Rating Scale,NRS)、Hollander切口愈合评分、术后住院时间和住院费用。结果2组患者均顺利完成手术。观察组经脐手术刀分碎完成后,均未见取物袋内亚甲蓝液体渗漏,腹腔镜检查腹盆腔也未见亚甲蓝液体和肌瘤组织碎片;对照组见肌瘤组织碎片数1~15个,中位数9个。观察组手术时间明显长于对照组[(114.5±24.3)min vs.(93.4±21.7)min,t=49.809,P=0.000],标本取出时间明显长于对照组[(23.8±12.7)min vs.(16.9±5.2)min,t=17.174,P=0.000]。2组术中出血量、术后24和48 h疼痛NRS评分、Hollander切口愈合评分、术后住院时间、住院费用差异无统计学意义(P>0.05)。术后病理富于细胞子宫平滑肌瘤观察组3例,对照组2例,子宫平滑肌肉瘤对照组1例,其余患者均为良性子宫平滑肌瘤。120例术后随访8~79个月,术后发生切口疝观察组2例,对照组1例;2组5例富于细胞子宫平滑肌瘤术后随访16~52个月,均未见复发和转移;对照组1例子宫平滑肌肉瘤术后5个月PET-CT提示腹盆腔、肝包膜下多发结节、肿块影伴18F-脱氧葡萄糖代谢异常增高,再次行经腹双侧卵巢、大网膜切除、腹盆腔种植灶减灭术和化疗,术后生存期16个月。结论腹腔镜子宫肌瘤剔除采用经脐手术刀肌瘤分碎术安全可行,有助于减少医源性肿瘤的种植和转移。Objective To compare the effect of transumbilical scalpel morcellation and traditional electric power morcellation in laparoscopic myomectomy.Methods From January 2014 to December 2019,120 cases of uterine fibroids underwent laparoscopic myomectomy.There were 60 cases treated with transumbilical scalpel morcellation(observation group)and 60 cases with electric power morcellation(control group).The number of fibroid fragments in the peritoneal cavity and puncture hole,operation time,specimen retrieval time,intraoperative blood loss,24 h and 48 h postoperative pain Numeric Rating Scale(NRS),Hollander Wound Evaluation Scale,postoperative hospital duration,and hospital expenses were compared between the two groups.Results Both groups of patients successfully completed the operation.In the observation group,after transumbilical scalpel morcellation was completed,there was no leakage of methylene blue fluid in the collection bag,and no methylene blue fluid or fibroid fragments was found in the peritoneal cavity under laparoscopy.The number of fibroid fragments in the observation group were 1-15(median,9).The operation time was longer than that of the control group[(114.5±24.3)min vs.(93.4±21.7)min,t=49.809,P=0.000].The specimen retrieval time was longer than that of the control group[(23.8±12.7)min vs.(16.9±5.5)min,t=17.174,P=0.000].There was no significant difference between the two groups in terms of intraoperative blood loss,24 h and 48 h postoperative NRS score,Hollander Wound Evaluation Score,postoperative hospital duration,and hospital expenses(P>0.05).Postoperative pathological outcomes showed 3 cases of cellular leiomyoma in the observation group and 2 cases in the control group,1 case of uterine leiomyosarcoma in the control group,and benign uterine leiomyoma in the remaining cases.A total of 120 patients were followed up for 8-79 months.There were 2 cases of incisional hernia in the observation group and 1 case in the control group.The 5 cases of cellular leiomyoma in the two groups were followed up for 1

关 键 词：腹腔镜 子宫肌瘤 组织分碎 脐 

分 类 号：R73[医药卫生—肿瘤]