腹腔镜下子宫肌瘤剔除术中子宫创面缝合方法的探讨

目的 探讨腹腔镜下子宫肌瘤剔除术中子宫创面连续垂直褥式填塞缝合法的安全性、有效性和可靠性.方法 2003年1月～ 2013年1月80例肌壁间肌瘤行腹腔镜下子宫肌瘤剔除术采用连续垂直褥式填塞缝合法（研究组）,132例肌壁间肌瘤行腹腔镜下子宫肌瘤剔除术采用传统缝合方法（对照组）.比较2组手术时间、出血量、手术前后血红蛋白差、术后病率、术后并发症、拔除盆腔引流管时间、术后住院时间、术后妊娠情况等.结果 研究组手术时间（115.7 ±43.7） min,与对照组（121.2±42.0）min无统计学差异,（t=-0.910,P=0.364）;研究组出血量中位数112.1 ml（5～550 ml）,与对照组中位数124.4 ml（5 ～500 ml）无统计学差异（Z=-1.414,P=0.149）;研究组术后血红蛋白下降（11.9±9.5）g/L,与对照组（14.0±8.7）g/L无统计学差异（t=-1.645,P=0.101）;研究组术后病率5.0％ （4/80）,与对照组12.1％（16/132）无统计学差异（Х^2=2.956,P=0.086）;研究组拔引流管时间（1.8±1.0）d,与对照组（1.9±1.1）d无统计学差异（t=-0.664,P=0.508）;研究组分娩率73.7％（14/19）与对照组58.8％（20/34）无统计学差异（Х^2 =1.170,P=0.279）;研究组术后住院时间（4.1±0.9）d,显著短于对照组（4.6±1.7）d,（t=-2.431,P=0.016）.2组无一例妊娠期发生子宫破裂.结论 腹腔镜下子宫肌瘤剔除术中子宫创面采用连续垂直褥式填塞缝合法安全、有效、可靠,值得临床推广应用.

An Improved Suture of Uterine Incision for Laparoscopic Myomectomy

Objective To investigate the safety,effectiveness and reliability of continuous vertical mattress suture of uterine incision during laparoscopic myomectomy.Methods From January 2003 to January 2013,80 cases of intramural myoma were performed laparoscopic myomectomy using continuous vertical mattress suture （study group）,while 132 cases underwent traditional suture surgery （control group）.The operation time,blood loss,hemoglobin change,postoperative morbidity,postoperative complication,time for pelvic drainage removal,hospital stay and postoperative pregnancy were compared between the two groups.Results There were no statistically significant differences between the study and control groups in operation time （115.7 ± 43.7） min vs.（121.2 ±42.0） min,t=-0.910,P=0.364],median blood loss 112.1 ml （5-550 ml） vs.124.4 ml （5-500 ml）,Z=-1.414,P=0.149],hemoglobin decrease （11.9±9.5） g/Lvs.（14.0±8.7） g/L,t=-1.645,P=0.101],postoperative morbidity 5.0% （4/80） vs.12.1% （16/132）,Х^2 =2.956,P =0.086],time for pelvic drainage removal （1.8 ± 1.0） d vs.（1.9±1.1） d,t=-0.664,P=0.507] and birth rate 73.7% （14/19） vs.58.8% （20/34）,Х^2=1.170,P=0.279].However,hospital stay in the study group was significantly shorter than that of the control group （4.1 ± 0.9） d vs.（4.6 ± 1.7） d,t =-2.431,P =0.016].No patients in the two groups suffered from uterine rupture during gestation period.Conclusion Continuous vertical mattress suture is a safe,effective and reliable suture in laparoscopic myomectomy,and is worthy of clinical application.