腹腔镜下子宫动脉阻断联合优势肌瘤剔除治疗多发性子宫肌瘤98例

目的评价腹腔镜下子宫动脉阻断联合优势肌瘤剔除（1aparoscopic uterine artery occlusion combined with ascendant myomectomy，LUAO—M）治疗多发性子宫肌瘤的中期疗效。方法在腹腔镜下分离解剖子宫动脉主干，双极电凝或PK刀闭合子宫动脉，然后电针切开肌瘤表面包膜，使用剥离器剥离、剔除优势肌瘤（所有浆膜下肌瘤和径线≥3cm的肌壁间肌瘤），合成线单层连续缝合子宫表面浆肌层切口。结果手术时间（102±36）min；术中出血量（88．7±58．4）ml；术后住院（7．9±0．2）d；术后病率5．1％（5／98）。术后发生肠梗阻1例，皮下气肿2例，无其他严重并发症发生。98例随访21—52个月，平均36．3月，平均随访3．6次，月经异常缓解率95．9％（4／98），子宫体积平均缩小57．7％，肌瘤复发率3．1％（3／98）。结论LUAO-M治疗多发性子宫肌瘤具有良好的临床效果及中期疗效。

Laparoscopic Uterine Artery Occlusion Combined with Ascendant Myomectomy for Multiple Uterine Myomas

Objective To evaluate the middle-term effect of laparoscopic uterine artery occlusion combined with ascendant myomectomy （LUAO-M） for multiple uterine myomas. Methods The uterine artery was isolated and occluded with Kleppinger bipolar forceps （Sabre 2400, ASPEN LABS USA） or PK forceps （Gyrus Medical Limited Inc UK） under a laparoseope. Then dissection was performed on the surface of pseudo capsule with Kleppinger unipolar needle （Sabre 2400, ASPEN LABS USA） or PK needle （Gyrus Medical Limited Ine UK） , and the target myoma was stripped out of the tumor bed with the Separate-Scoop device. Afterwards, repair of the incision was carried out in one layer with interrupted single stitch by Absorbable VICRYL suture （ Johnson VICRYL ETHICON USA）. Results The mean operation time was （102 ± 36） rain and mean blood loss was （88.7 ± 58.4） ml. The mean hospital stay after the operation was （7.9 ± 0.2） d, and febrile morbidity was 5.1% （5/98）. Complications included two cases of subcutaneous emphysema and one case of ileus; no other severe complications occurred. Of the patients, 98 cases were followed-up for 21 to 52 months （mean, 36.3 months）, during the period they were visited by a mean of 3.6 times, which showed a correction rate of menstruation abnormality of 95.9% （4/98） , rate of uterine volume reduction of 57.7% , and rate of recurrent myoma of 3.1% （3/98）. Conclusion LUAO-M shows a good clinical outcome and middle-term effect for multiple uterine myomas.