经阴道与经腹腔镜子宫肌瘤剔除术的临床效果分析

目的:讨论经阴道子宫肌瘤剔除及腹腔镜下肌瘤剔除的临床效果。方法:回顾性分析2006年1月～2008年10月我院采用经腹腔镜和经阴道子宫肌瘤剔除的病例68例,分析两组手术时间、术中出血量、剔除肌瘤个数、住院时间及术后恢复情况。结果:两组患者在手术时间、肌瘤大小、术后病率、术后排气时间及住院天数上相比较无显著差异(P>0.05),但腹腔镜组患者术中出血多于阴式组,阴式组患者所剔除的肌瘤数目多于腹腔镜组(P<0.05)。结论:经阴道子宫肌瘤剔除术出血少,剔除的肌瘤数目多,但其适应证较局限。经腹腔镜子宫肌瘤剔除具有创伤小,粘连少,但易致小的肌壁间肌瘤遗漏的特点。子宫肌瘤挖除手术方式的选择要在术前仔细评估,根据肌瘤的部位、肌瘤的数目和手术者的经验酌情选择合适的术式。

Comparison between transvaginal and laparoscopic approach

Objective ： To compare the clinic results of myomectomy by transvaginal or laparoscopic approach. Methods ： Sixty-eight cases undergone the two separate approaches for myomectomy were retrospectively examined on the records of the duration of the procedure, intraoperative bleeding amount, average number of the tumor removed, length of hospital stay and post-operative recovery, from Jan. 2006 through Oct. 2008. Results ：There was no statistical difference among the factors such as time consumption for the operation, myoma size, post-operative morbidity, restoration of the bowel movement and length of hospital stay in the two groups （P 〉0.05）. The amount of bleeding during the procedure was less in transvaginal approach than that of laparoscopic myomectomy, but the number of the tumor being removed were more in transvaginal approach than that in myomectomy by laparoseopy. Conclusion ： Transvaginal myomectomy has the advantages of less blood loss, more number of tumor resection, but with limited indications. However, laparoscopic approach is superior to the transvaginal one in less trauma or adhesion of pelvic organs, but the intramural myoma can be missed. Consequently, the choice of the approach should rely on the indications, site and number of the tumor as well as the experience of the surgeon.