子宫肌瘤剔除术三种术式临床效果比较

目的:比较开腹、阴式、腹腔镜下3种途径子宫肌瘤剔除术的优缺点。方法:回顾分析开腹子宫肌瘤剔除术42例(开腹组)、阴道子宫肌瘤剔除术26例(阴式组)和腹腔镜下子宫肌瘤剔除术25例(腹腔镜组)的临床资料。结果:阴道组手术时间最短(84.2±29.8min),开腹组次之(102.7±30.8min),腹腔镜组手术时间最长(129.6±39.7min),3组间比较差异有统计学意义(P<0.05)。术中出血量阴式组最少(122.3±44.1ml),与开腹组、腹腔镜组比较差异有统计学意义(P<0.05)。肌瘤最大直径开腹组最大(8.0±2.8cm),与腹腔镜组、阴式组比较差异有统计学意义(P<0.05)。术后排气时间阴式组最短(21.0±4.8h),腹腔镜组次之(24.4±5.1h),开腹组时间最长(30.5±4.7h),3组间比较差异有统计学意义(P<0.05)。术后病率3组间比较差异无统计学意义(P>0.05)。术后住院时间开腹组时间最长(7.5±1.1d),与阴式组、腹腔镜组比较差异有统计学意义(P<0.05)。结论:腹腔镜下子宫肌瘤剔除术、阴式子宫肌瘤剔除术具有手术创伤小、术后恢复快等优点,而开腹子宫肌瘤剔除术适应证范围更广,3种术式不能完全互相替代。

Clinical Comparison of Three Ways of the Hysteromyomectomy

Objective:To compare the advantages and disadvantages of transabdominal myomectomy(TAM),transvaginal myomectomy(TVM)and laparoscopic myomectomy(LM).Methods:The clinical data of 42 cases of TAM(group TAM),26 cases of TVM(group TVM)and 25 cases of LM(group LM)were retrospectively reviewed.Results:The operation time of the group TVM was the shortest(84.2min±29.8min),the group TAM occupied longer time than the group TVM(102.7min±30.8min),and the group LM occupied the longest time(129.6min±39.7min).There were significant differences among the three groups(P<0.05).The intraoperation hemorrhage volume was significantly less in the group TVM(122.3±44.1)mL than that in the group TAM and the group LM(P<0.05).About the longest diameter of the myomas,the group TAM was arranged the first place(8.0±2.8)cm which was significantly longer than the that of the other two groups.About the time of gas passage by anus,the group TVM occupied the shortest time(21.0±4.8)h,the group LM occupied longer time than the group TVM(24.4±5.1)h,and the TAM occupied the longest time(30.5±4.7)h.There was significant differences among the three groups(P<0.05).As to the post-operative morbidity,there was no statistical difference.The length of stay of the group TAM(7.5±1.1)d was significantly longer than that of the other two groups.Conclusion:Both LM and TVM have advantages of micro-invasion and rapid recovery,but TAM has a great variety of indications,which could not entirely supersede each other.