腹腔镜子宫肌瘤切除术经阴道取标本的临床效果探讨  

Clinical effect of transvaginal specimen extraction in laparoscopic myomectomy

作　　者：刘润萍[1] 田赟[1] 董俊英[1] 郭霞[2] 常晓玫[1] LIU Run-ping;TIAN Yun;DONG Jun-ying(Department of Gynecology,Hanzhong People's Hospital,Hanzhong 723000,China)

机构地区：[1]汉中市人民医院妇科,陕西汉中723000 [2]西安医学院附属汉江医院妇产科

出　　处：《腹腔镜外科杂志》2023年第5期370-373,共4页Journal of Laparoscopic Surgery

摘　　要：目的:探讨腹腔镜子宫肌瘤切除后经阴道切开后穹隆取标本的临床可行性与安全性。方法:将2018年10月至2020年10月行腹腔镜子宫肌瘤切除术的211例患者随机分为研究组(n=116)与对照组(n=95),研究组无需使用肌瘤粉碎器,将标本直接装入自制标本隔离袋,经阴道切开后穹隆取出标本。对照组采用经阴道传统方法切开后穹隆取出肌瘤。对比分析两组阴道后穹隆切开所需时间、出血量及术后发热、直肠损伤情况。结果:研究组中2例患者术中发现子宫直肠凹陷严重粘连封闭,肌瘤经腹壁小切口取出,予以排除,最终纳入114例患者,均经阴道切开后穹隆完整取出标本,无并发症发生。研究组切开后穹隆所需时间、出血量少于对照组,差异有统计学意义(P<0.01);两组术后发热、直肠损伤差异无统计学意义(P>0.05)。结论:腹腔镜子宫肌瘤切除后经阴道切开后穹隆取出标本操作简单、安全,无肿瘤组织碎屑飞溅、种植、播散风险,无并发症发生,无需特殊医疗器械,既符合无瘤技术原则,又达到了微创目的。Objective:To investigate the clinical feasibility and safety of laparoscopic myomectomy followed by transvaginal incision of the posterior fornix to remove myomas.Methods:From Oct.2018 to Oct.2020,211 patients who underwent laparoscopic myomectomy were randomly divided into study group(n=116)and control group(n=95).In the study group,myomectomy crusher was not used,the specimen was directly packed into a self-made specimen isolation bag,and the fibroids were removed via the transvaginal incision of the posterior fornix.In the control group,the fibroids were removed by the traditional vaginal incision of the posterior fornix.The time required to open the posterior vaginal fornix,intraoperative blood loss,postoperative fever,and postoperative rectal injury were compared and analyzed between the two groups.Results:In the study group,2 cases of severe intraoperative adhesions were found in the rectovaginal pouch,and the myomas were removed through small incision in the abdominal wall,while in the other 114 cases,all the myomas were completely removed via a vaginal incision of the posterior fornix without complications.The time required for transvaginal incision of the posterior fornix and the bleeding volume of the study group were significantly less than those of the control group,and the differences were statistically significant(P<0.01);the differences in postoperative fever and rectal injury between the two groups were not statistically significant(P>0.05).Conclusions:After laparoscopic myomectomy,removal of the fibroids via the transvaginal incision of the posterior fornix can avoid the risk of spattering,planting and spreading of tumor tissues,decrease the incidence of complications,and avoid special medical devices.This procedure is in accordance with the tumor-free principle and achieves the minimally invasive goal.

关 键 词：子宫肌瘤切除术 腹腔镜检查 自制标本隔离袋 经阴道 取标本 

分 类 号：R713.4[医药卫生—妇产科学]