免气腹与气腹腹腔镜下子宫肌瘤剔除术的临床比较研究

目的探讨免气腹腹腔镜子宫肌瘤剔除术的临床应用价值。方法选取2007年5月～2008年5月在我院行免气腹腹腔镜下子宫肌瘤剔除术（免气腹组）的子宫肌壁间肌瘤43例，及同期气腹腹腔镜下子宫肌瘤剔除术（气腹组）40例进行回顾性对照研究，比较2组手术时间、术中出血量、术后腹腔引流量、术后胃肠功能恢复时间及术后半年的复发情况。结果2组手术均在腹腔镜下顺利完成，无术中、术后并发症。与气腹组相比，免气腹组手术时间短[（46．2±17．2）min vs （59．4±20．8）min，t=-3．160，P=0．002]，术中出血量少[（235．3±83．1）ml vs （310．5±99．4）ml，t=-3．749，P=0．000]，术后24h腹腔引流量少[108．4±23．4）ml vs （125．9±35．1）ml，t=-2．690，P=0．010]，术后胃肠功能恢复快[肛门首次排气时间（17．4±7．2）h vs （21．6±9．8）h，t=-2．236，P=0．023；首次排便时间（23．5±8．1）h vs （31．0±9．4）h，t=-3．902，P=0．001]。2组术后2个月阴道B超均未发现肌瘤，术后6个月阴道B超提示气腹组1例子宫后壁肌层内见一直径12mm的小肌瘤，2组复发率差异无显著性（0／43 vs 1／40，P=0．482）。结论与气腹腹腔镜子宫肌瘤剔除比较，免气腹法具有手术时间短、术中出血少、手术操作简便、术后病人恢复快等优点，对于拟施行子宫肌瘤剔除术的患者是一种较好的手术方式。

Comparison of Myomectomy with Gasless Laparoscopy and Pneumoperitoneal Laparoscopy

Objective To compare the effectiveness of gasless laparoscopy and CO2-insufflated pneumoperitoneal laparoscopy in myomeetomy, Methods A total of 83 patients with uterine myoma were treated in our hospital from May 2007 to May 2008. Of the cases, gasless laparoscopy （GLM） was used in 43 patients and pneumoperitoneal laparoscopy （LM） were employed in 40. The operation time, intraoperative blood loss, volume of intra-abdominal drainage, postoperative recovery time of gastrointestinal function, and rate of recurrence in half a year were compared between the two groups. Results The operation was completed in both the groups without intraor post-operative complications occurred. Compared to the LM group, the GLM group had significantly shorter operation time [（46.2±17.2） min vs （59.4±20.8） min, t = -3. 160, P=0.002], less blood loss [（235.3 ±83.1） ml vs （310.5±99.4） ml, t= -3.749,P=0.000], lower volume ofintra-abdominal drainage [（108.4 ±23.4） ml vs （125.9 ±35.1） ml, t = - 2. 690, P = 0.010 ] , and quicker recovery of gastrointestinal function [ first deflation ： （ 17.4 ± 7.2） h vs （21.6 ± 9.8 ） h, t= -2.236, P=0.023; and first defecation： （23.5±8.1） h vs （31.0±9.4） h, t= -3.902, P=0. 001]. Two months after the operation, vaginal ultrasonography showed no myoma in the patients. Re-examination in 6 months showed a 12-mm myoma in the muscle layers of the posterior uterine wall in one patient in the LM group. The recurrence rate was not significantly different between the two groups. Conclusion Compared to conventional laparoseopy, gasless laparoscopy has an advantage of short operation time, less blood loss, and short recovery time. It is a good choice for myomectomy.