腹腔镜下子宫肌瘤剔除术93例临床分析

目的:探讨腹腔镜下子宫肌瘤剔除术的手术适应症、手术效果及手术技巧。方法:选择我院2003年1月～2005年5月腹腔镜下子宫肌瘤剔除术93例病例进行回顾性分析。结果:93例手术均获成功,其中单发肌瘤71例,多发性肌瘤22例;肌瘤直径为0.2～14cm;手术缝扎止血21例,其余采用套扎止血和电凝止血;手术时间40～300min,平均(100.54±47.35)min;术中出血量5～600ml,平均(68.28±111.39)ml;术后住院时间4～13d,平均(7.49±1.95)d;无明显并发症。单发肌瘤组手术时间、术中出血量与多发肌瘤组比较均无显著性差异(P均>0.05);壁间深部肌瘤组手术时间、术中出血量均明显多于前壁、后壁肌瘤组(P均<0.01)。后壁肌瘤组术中出血量明显多于前壁肌瘤组(P<0.01),而手术时间无明显差异(P>0.05);肌瘤直径≥6cm组术中出血量多于肌瘤直径<6cm组(P<0.05),而手术时间无明显差异(P>0.05)。结论:腹腔镜下子宫肌瘤剔除术具有微创手术的优点,是有效地保留子宫的手术方法;术中出血量和手术时间主要与肌瘤生长部位及其大小有关。术者娴熟的腹腔镜操作技巧和合理选择适应症是手术成功的关键。

Clinical Analysis of 93 Cases of Laparoscopic Myomectomy

Objective:To explore the indications , therapeutic effect and surgical technique of laparoscopic myomectomy.Methods:93 cases of laparoscopic myomectomy in our hospital from January 2003 to May 2005 were retrospectively analyzed.Results:Success was achieved in all operations. There were 71 cases with single myoma,22 cases with multiple myoma. The diameter ranged from 0.2 to 14 cm.22 cases were used suturing to homeostasis, the other cases used cish-endo-loop or electric coagulation.The operative time was 40~300 rain(mean, 100.54±+47.35 min), and the intraoperative bleed loss was 5~600 ml (mean,68.28±111.39 ml).The postoperative hospital stay was 4~13 days(mean, 7.49±1.95).No significant complication was found. The average operative time and bleed loss had no significant deviations between single myoma and multiple myoma groups (P>0.05).Longer operation time and more blood loss were observed in patients with intramural deep part myoma than anterior wall, posterior wall' s myoma(P<0.01).Posterior wall' s myoma had more bleed loss than anterior wall' myoma(P<0.01), while operative time had not (P>0.05).The blood loss was more when the myoma was larger than 6 cm(P<0.05), while operative time had not (P>0.05).Conclusion:Laparoscopic myomectomy has advantages of minimal injury, it is an effective means to preserve uterus. The bleeding quantity during and the operative time are determined by the hysteromyoma's location and its size.Operate with practiced techniques and suitable patient car: result in satisfactory clinical outcomes.