腹腔镜与开腹子宫肌壁间肌瘤剔除手术的比较

目的探讨腹腔镜在子宫肌壁间肌瘤剔除术中的临床应用价值。方法2006年1月～2007年12月对120例子宫肌壁间肌瘤按随机数字表法分组并征求患者同意后,52例行腹腔镜下子宫肌瘤剔除术（腹腔镜组）,68例行开腹子宫肌瘤剔除术（开腹组）,对2组手术时间、术中出血量、术后病率、并发症、住院时间、术后随访情况进行比较。结果手术时间腹腔镜组长于开腹组[（106.3±54.9）minvs（66.5±7.3）min,t=5.918,P=0.000];术中出血量腹腔镜组略少于开腹组[10～300ml（中位数50ml）vs20～200ml（中位数50ml）,Z=-1.998,P=0.046];术后病率腹腔镜组显著低于开腹组[7.7%（4/52）vs30.9%（21/68）,χ2=9.608,P=0.002];并发症发生率腹腔镜组与开腹组相似[3.8%（2/52）vs8.3%（3/36）,χ2=0.000,P=1.000];住院时间腹腔镜组明显短于开腹组[（7.5±1.4）dvs（10.4±1.2）d,t=-12.201,P=0.000];术后随访时间腹腔镜组与开腹组相似[（9.7±2.3）月vs（9.6±1.8）月,t=0.267,P=0.790],均无复发;腹腔镜组术后月经恢复正常率与开腹组相似[94.4%（17/18）vs90.5%（19/21）,χ2=0.000,P=1.000]。结论腹腔镜下子宫肌壁间肌瘤剔除术与开腹手术相比效果无差异,术后恢复优于开腹手术,是一种理想的手术方式。

Comparison between Laparoscopic and Open Myomectomies for Intramural Myoma

Objective To evaluate the value of laparoscopy in the treatment of intramural myoma.Methods Totally 120 cases of intramural myoma were randomly divided into laparoscopy（n=52）and open groups（n=68）.Clinical data,including operation time,intraoperative blood loss,rates of postoperative pyrexia and postoperative complications,length of hospital stay and follow-up,were compared between the two groups.Results Compared to the open group,the laparoscopy group had significantly longer operation time （106.3±54.9）min vs（66.5±7.3）min,t=5.918,P=0.000],less blood loss 10-300 ml（median,50 ml）vs 20-200 ml（median,50 ml）,Z=-1.998,P=0.046],lower rate of postoperative pyrexia 7.7%（4/52）vs 30.9%（21/68）,χ2=9.608,P=0.002],similar rate of postoperative complications 3.8%（2/52）vs 8.3%（3/36）,χ2=0.000,P=1.000],shorter hospital stay （7.5±1.4）d vs（10.4±1.2）d,t=-12.201,P=0.000],and similar length of follow-up （9.7±2.3）months vs（9.6±1.8）months,t=0.267,P=0.790] and rate of normal menses 94.4%（17/18）vs 90.5%（19/21）,χ2=0.000,P=1.000].Conclusions Laparoscopy is as effective as open surgery for intramural myoma.While the laparoscopy leads to better postoperative recovery than the open surgery.