子宫肌瘤腹腔镜剥除与开腹剥除的配对研究

目的对比研究腹腔镜与开腹行子宫肌瘤剔除的优点和风险。方法收集2002年5月～2004年5月间48例子宫肌瘤(浆膜下或肌壁间)手术病人。所有病人分成腹腔镜组和开腹组,测定两组的手术时间、手术出血量、术后最高体温、体温恢复正常天数、下床活动时间、肛门排气时间、住院天数、术后用镇痛药与否、术后3d白细胞分类及计数正常与否、术后有无并发症,并进行1∶1的配对研究。结果两组病人无手术并发症,腹腔镜组无中转开腹手术。腹腔镜组手术出血量、术后体温恢复时间、下床活动时间、肛门排气时间、住院天数、镇痛药使用率和血常规正常时间较开腹组少;但手术时间较长,考虑与手术操作熟练程度有关。结论腹腔镜下子宫肌瘤剔除术是一种安全有效的手术方法,较开腹手术损伤小、出血少、恢复快。

Pairing Study of hysteromyomectomy by laparoscope and by laparatomy

[Objective] To compare the advantage and risk between laparoscopic myomectomy and laparohysteromyomectomy. [Methods] Forty-eight patients of Hysteromyoma under operation (Subserous or intramural) were collected from May, 2002 to May, 2004. The patients were divided into 2 groups: laparoscopic myomectomy group and laparohysteromyomectomy group. Recording the time of operation, bleeding volume during operation, the highest body temperature after operation, the number of day of body temperature reverting to normal, the time of out-of-bed activity, the time of passage of gas by anus, hospital day, with or without pain-killer after operation, with or without normal leukocyte differential count after 3 days of operation, and with or without complications after operation, the pairing study of 1 to 1 was accomplished. [Results] There are no operation complications of the 2 groups. No laparotomy was demanded during operation in laparoscopic group. The bleeding volume during operation, the time of body temperature reverting to normal after operation. The time of out-of-bed activity, the time of passage of gas by anus, hospital day, the usage rate of pain-killer and the time of hemogram reverting to normal in laparoscope group were less than that in laparotomy group. But operation time was longer in laparoscope group, which may be related to skilled extent of operative procedure. [Conclusions] Laparoscopic myomectomy was a safe and effective operation method, whose damage was smaller, bleeding volume less, and recovery was faster compared with laparotomy.