不同术式子宫动脉阻断后行子宫肌瘤剔除治疗子宫肌瘤的临床研究

目的探讨子宫肌瘤剔除合并子宫动脉阻断治疗子宫肌瘤的临床效果及可行性,比较腹腔镜手术与剖腹手术的优势。方法对2002年10月至2007年9月收住我院要求保留子宫的子宫肌瘤手术患者共221例,随机分为腹腔镜组和剖腹组,采用子宫肌瘤剔除术中先阻断双侧子宫动脉的方法治疗子宫肌瘤。其中腔镜组89例、剖腹组132例。两组肌瘤数目、大小、发病年龄两组间差异无显著性。通过统计手术时间、术中出血量、住院天数等,以及观察术后定期随访1年,观察月经症状的改变、B超监测子宫大小及肌瘤复发情况,并将两组进行对照比较。结果腔镜组和剖腹组手术时间两组统计学无显著差异（90.6vs103.8min P〉0.05） 但寻找子宫动脉时间腔镜组较剖腹组短（21.4vs30.6min P〈0.05） 术中出血量剖腹组较腔镜组有所增加（87.5vs101.2ml P〈0.05） 住院天数腔镜组明显少于剖腹组（7.28vs11.13d P〈0.05）。术后随访1年,腔镜组失访12例,剖腹组失访17例,以腔镜组77例、剖腹组115例进行统计。腔镜组和剖腹组月经症状缓解率为92.64%和97.97% 腔镜组与剖腹组两组肌瘤复发率分别为3.89%和3.47%,两组统计学无显著差异,P〉0.05。结论子宫肌瘤剔除前先阻断子宫动脉,能明显减少术中出血,更好地缓解月经过多等症状,延缓了肌瘤的复发,在腔镜下行此手术较剖腹手术更有优势,是一种安全、有效的治疗子宫肌瘤并能保留子宫的新方法。

Clinical study of uterine arterial blocking and myomectomy in the treatment of uterine myoma

Objective To evaluate the value of uterine arterial blocking and myoectomy in the treatment of uterine myoma,and compare advantage of operation by laparoscopy and abdominal. Methods From October 2002 to September 2007,221 women with fobroids warranting surgical treatment in our hospital were classified into two groups according to different treatment modes. Study group were 89 patients who received operation by laparoscopy; control group were 132 patients by abdominal approach,the two groups were received uterine arterial blocking and myomectomy. There were no difference between the groups in age of patients.the diameter and the number of myoma. Observed the time of operation and intraoperative blood loss,and days in hospital. Follow-up time was more than 12 months, analyzed postoperative improvement of memorrhea and recurrence of myoma. Results There were no difference of the operative time between the twe groups （90.6 vs 103.Smin;P〉0.05）,but there were difference of time of looking for uterine arterial blocking （21.4 vs 30.6min ;P〈0.05）.Intraoperative blood loss of the study group was less than the control group（87.5 vs 101.2ml;P〈0.05）;the average hospitalization time of study group was shorter than control group （7.28 vs 11.13d;P〈0.05）;192 patients were followed up ,the improvement rate of memorrhea in study group and control group was 92.64% vs 97.97%; the rate of recurrence of myoma was 3.89%和 3.47%.Two gruops were no difference （P〉 0.05）. Conclusion The procedure of uterine arterial blocking and myomectomy presents less blood loss,more improvement of memorrhea and lower recurrence of myoma. Compared to laparotomy, uterine arterial is found easily in laparoscopic approach,it is an effective and promising new method for uterine leiomyoma.