悬吊式腹腔镜与腹腔镜联合小切口子宫肌瘤剔除术的比较研究

目的评估腹腔镜辅助下小切口行子宫肌瘤剔除术（laparoscopically assisted mini—incision myomectomy，LAMM）的临床应用价值。方法80例子宫肌瘤患者随机分为两组：LAMM组40例，在腹腔镜下剥离肌瘤一半后扩大腹壁正中辅助穿刺点至4～5cm长切口，在腹壁切口外完成整个肌瘤剔除术及子宫创面的缝合；40例行悬吊式腹腔镜下子宫肌瘤剔除术（laparoscopic myomectomy，LM）（LM组），即全部手术操作均在腹腔镜下完成。比较两组术中出血量、手术时间、术后24h血红蛋白浓度差（△Hb）、肠功能恢复时间、住院时间以及并发症等。结果两组均成功完成手术，无一例中转开腹。LAMM组手术时间、术中出血量分别为（75．5±25．7）min、（71．9±19．0）ml，LM组分别为（96．0±26．2）min、（96．3±32．4）nd，组间比较有显著性差异（P〈0．01）；LAMM组AHb为（1．2±0．6）g／L，明显低于LM组的（1．7±0．6）g/L（P〈0．05）；两组术后排气时间、术后住院时间比较无显著性差异（P〉0．05）。LAMM组发生皮下气肿1例，肩背酸痛2例；LM组皮下血肿1例，肠梗阻1例，术后1年有1例复发。结论LAMM术保留了腹腔镜手术的优点，降低了手术难度，缩短了手术时间，减少术中出血，值得推广运用。

Effect Comparison of Laparoscopic Myomectomy and Laparoscopically Assisted Mini-incision Myomectomy for Hysteromyoma

Objective To compare the operative data and early postoperative outcome of laparoscopic myomectomy （LM） and laparoscopically assisted mini-incision myomectomy （LAMM） under isobaric gasless, and to evaluate the clinical value of LAMM. Methods 80 hysteromyoma women with operative indications were randomized into two groups with 40 cases for each, and then LAMM and LM were performed respectively in LAMM group and LM group. The intraoperative blood loss, operative duration, hemoglobin concentration difference （ △ Hb） at 24 hours after the operation, gastrointestinal function recovery time, hospital stay and complications rate were compared between two groups. Results All cases accomplished operations successfully without converting to open operation. The operative duration and intraoperative blood loss were 75.5 ± 25.7 min and 71.9 ± 19.0 ml in LAMM group, and 96.0 ± 26.2 min and 96.3 ± 32.4 ml in LM group, there was significant difference between two groups （P 〈 0.01 ）. The △ Hb of LAMM group was （ 1.2 ± 0.6） g/L, and obviously lower than （ 1.7 ±0.6） g/L of LM group （ P 〈 0.05 ）. There was no statistic difference in gastrointestinal function recovery time and postoperative hospital stay between two groups （ P 〉 0.05 ）. One case of subcutaneous emphysema and 2 of shoulder-back soreness was found in LMM group, and 1 of ecchymoma, 1 of intestinal obstruction, and 1 of recurrence in LM group. Conclusion LAMM is not only conserve the advantages of LM, but also can shorten the operative duration and decrease the blood loss, therefore it is deserve to be popularized.