复杂子宫肌瘤腹腔镜下子宫全切术的临床对比研究

目的探讨阔韧带肌瘤、子宫下段肌瘤、宫颈肌瘤等复杂子宫肌瘤腹腔镜下全子宫切除的可行性。方法比较我院2009年12月～2012年12月166例复杂子宫肌瘤与170例非复杂子宫肌瘤腹腔镜下子宫切除，比较2组手术时间、术中出血量、术后排气时间、术后病率和中转开腹率。结果2组手术时间（112．2±15．3）minVS．（110．3±16．1）min，t=1．088，P=0．277]、术中出血量（117．0±35．3）ml VS．（110．8±37．8）ml，t=1．525，P=0．128]、术后排气时间（20．8±2．7）hVS．（21．3±2．3）h，t=1．797，P=0．073]、术后病率6．3％（10／159）vs．7．3％（12／165），ｘ２=0．124，P=0．725]、中转开腹率4．2％（7／166）VS．2．9％（5／170），ｘ２=0．397，P=0．529）]均无统计学差异。分别于术后1、2、6个月进行随访，复杂性子宫肌瘤组159例、非复杂性子宫肌瘤组165例均恢复良好，无并发症发生。结论复杂子宫肌瘤在腹腔镜下行全子宫切除是可行的，若瘤体基底部较宽，位置较低，术中适时中转开腹，可防止并发症发生。

Homparative Study of Total Laparoscopic Hysterectomy for Complicated Hysteromyoma

Objective To investigate the feasibility of total laparoscopic hysterectomy for complicated hysteromyoma, such as broad ligament myoma, lower uterine fibroids, or cervical myoma. Methods From December 2009 to December 2012, we performed laparoscopic hysterectomy on 166 patients with complicated hysteromyoma and on 170 patients with common hysteromyoma. The operation time, intraoperative blood loss, recovery time of gastrointestinal function, postoperative morbidity, and the rate of conversion to laparotomy were compared between the two groups respectively. Results No significant differences were detected in operation time （ 112.2±15.3 ） min vs. （ 110.3 ± 16.1 ） min, t = 1. 088, P = 0. 277 ], intraoperative blood loss （ 117.0 ± 35.3 ） ml vs. （110.8±37.8） ml, t = - 1.525, P =0. 128], recovery time of gastrointestinal function （20.8 ±2.7） h vs. （21.3 ±2.3） h, t = 1. 797, P = 0. 073 ] , postoperative morbidity 6.3% （10/159） vs. 7.3 % （ 12/165 ） , X2 = 0. 124, P = 0. 725 ] , and the rate of conversion to laparotomy （4.2% vs. 2.9% , X2 = 0. 397, P = 0. 529） between the two groups. Both the groups were followed up at 1, 2, and 6 months after procedure, and none of the patients showed severe postoperative complications. Conclusions Total laparoscopic hysterectomy for complicated hysteromyoma is feasible. To prevent complications, it should be converted to laparotomy timely when the myoma has a wide base or is located at lower position.