腹腔镜在子宫肌瘤剔除术中的价值探讨

目的探讨分析对子宫肌瘤患者利用腹腔镜进行肌瘤剔除手术的疗效。方法在皖北煤电集团总医院2010年1月—2012年12月收住的子宫肌瘤患者中,抽取适合腹腔镜子宫肌瘤剔除术的患者96例,随机将其中48例腹腔镜下子宫肌瘤剔除术作为观察组,48例开腹子宫肌瘤剔除术作为对照组,将2组患者的术中出血量、手术时间、术后肛门排气、住院时间及术后并发症情况及术后3月性激素测定进行对比。结果观察组手术时间（95.7±35.5）min,长于对照组手术时间（62.0±18.3）min,差异具有统计学意义（P〈0.05）,观察组在患者术中出血量（78.0±41.5）ml,肛门排气时间（20.5±8.0）h,保留导尿时间（18.5±4.5）h,术后住院时间（5±2）d,较对照组术中出血量（136.0±50.2）ml,肛门排气时间（40.5±13.0）h,保留导尿时间（43±13）h,术后住院时间（8.0±1.5）d明显缩短,差异均具有统计学意义（P〈0.05）,对照组术后切口感染8例,尿路感染5例,呼吸道感染6例,观察组除1例上呼吸道感染外无切口和泌尿系感染,2组差别有统计学意义（P〈0.05）。观察组术后E2（118±48）pmol/L,FSH（10±5）U/L,LH（11±4）U/L,对照组术后E2（135±57）pmol/L,FSH（9±3）U/L,LH（13±5）U/L,2组比较差异无统计学意义（P〉0.05）。结论腹腔镜剔除子宫肌瘤在适宜的手术适应证下,具有创伤小、住院时间短、恢复快的优点,且不影响卵巢功能,值得在临床诊疗中推广应用。

Utility of laparoscopy in myomectomy therapy

Objective To observe the therapeutic efficacy of laparoscopic myomectomy（LM） in patients with hysteromyoma. Methods Total 96 patients with hysteromyoma in our hospital between January 2010 and December 2010 were enrolled in this study and randomly assigned into two groups,48 patients in the observation group underwent the LM,while48 patients in the control group received the abdominal myomectomy. The peroperative bleeding,operation time,the time to first flatus,hospital stay,incidence of postoperative complications and sex hormone levels within 3 months after the surgery were compared between the two groups. Results The operating time in the observation group（95. 7 ± 35. 5） min was longer than that in the control group（62. 0 ± 18. 3） min,the difference was statistically significant（ P〈0. 05）;between the observation group and control group,there was significant difference in peroperative bleeding（78. 0 ± 41. 5） ml vs.（136. 0 ± 50. 2） ml,the time to first flatus（20. 5 ± 8. 0 h vs. 40. 5 ± 13. 0 h）,time keeping catheter（18. 5 ± 4. 5） h vs.（43 ± 13） h,hospital stay（5 ± 2 d vs. 8. 0 ± 1. 5 d）,P〈0. 05. In the control group,8 cases were with postoperative incision infection,5 with urinary tract infection,6 cases with respiratory tract infection;while in the observation group,only1 case was with respiratory tract infection,the difference in the incidence of postoperative complications was significant between the two groups（P〈0. 05）. The postoperative levels of E2,FSH and LH were（118 ± 48） pmol /L,（10 ± 5） U /L and（11 ± 4）U /L in the observation group and（135 ± 57）pmol /L,（9 ± 3）U /L and（13 ± 5）U /L in the control group,respectively,there were no significant differences to the two groups（ P〈0. 05）. Conclusion When the surgical indications are appropriate,LM for patients with hysteromyoma is safe and effective,with advantages of small trauma,shorter hospitalization time and rapid recovery,and is worthy of popularization the clin