子宫肌瘤剔除术三种手术方式的疗效观察

目的探讨经阴道子宫肌瘤剔除术（TVM）、腹腔镜下子宫肌瘤剔除术（LM）和经腹子宫肌瘤剔除术（TAM）的优缺点和适应证。方法将99例要求行子宫肌瘤剔除术的子宫肌瘤患者随机分为TVM组、LM组和TAM组，各33例，并比较三组的手术时间、术中出血量、术后排气时间、术后住院时间和住院费用。结果99例患者的手术均顺利完成；TVM组及TAM组手术时间较LM组明显缩短（P〈0．05）；TVM组术中出血量最少，TAM组最多（P〈0．05）；TVM组和LM组术后排气时间和术后住院时间较TAM组明显缩短（P〈0．05）；LM组住院费用明显高于TvM组和TAM组（P〈0．05）。结论TVM与LM均具有创伤小、术后恢复快、疼痛发生率低等优点；TAM具有剔除子宫肌瘤数目多，大小、深浅不限的优点；医生应根据患者的临床特征个体化选择理想的治疗方式。

Three types of myomectomy for hysteromyoma

Objective To explore the advantage and disadvantage and the indications of transvaginal my- omectomy （TVM）, laparoscopic myomectomy （LM）, and transabdominal myomectomy （TAM） for hysteromy- oma. Methods 99 patients with hysteromyoma who required for myomectomy were randomly divided into TVM group, LM group, and TAM group, 33 for each group. Surgical duration, intraoperative blood loss, postoperative flatus time, postoperative length of hospital stay, and medical costs were compared among the three groups. Re- sults All the procedures were successfully completed in 99 patients. Surgical duration was obviously shortened in TVM group and TAM group than in LM group （P 〈0.05 ）. Intraoperative blood loss was the least in TVM group but was the most in TAM group （P〈0.05）. Postoperative flatus time and length of hospital stay were significantly shorter in TVM group and LM group than in TAM group （P 〈0.05 ）; medical costs was significantly greater in LM group than in TVM group and TAM group （P〈0.05）. Conclusions Both transvaginal myomectomy and laparo- scopic myomectomy are less invasive, and have rapid postoperative recovery and a lower incidence rate of pain; transabdominal myomectomy has the advantage of excluding the number of uterine fibroids, and no limitation in size and depth.The doctor should select an ideal treatment method basing on the patients＇ individual clinical fea-tures.