无气腹皮下悬吊式腹腔镜与传统气腹腹腔镜子宫肌瘤剔除术的临床比较

目的探讨无气腹皮下悬吊式腹腔镜子宫肌瘤剔除术的应用价值。方法对比分析2006年10月～2008年2月我院同期施行无气腹与气腹腹腔镜子宫肌瘤剔除术的手术情况,比较两者手术时间、术中出血量、排气时间、住院时间、并发症及相关费用情况。结果2组患者均无术中、术后并发症发生。无气腹组手术时间（99.2±35.4）min,气腹组（102.7±28.8）min,2组比较差异无显著性（t=-0.411,P=0.682）。无气腹组术中出血量（77.0±48.3）ml与气腹组（89.6±53.8）ml相比,差异无显著性（t=-0.940,P=0.351）。无气腹组排气时间（1.8±0.5）d与气腹组（2.1±0.3）d相比,差异有统计学意义（Mann-WhitneyU=304.000,P=0.013）。无气腹组住院时间（8.7±2.9）d显著短于气腹组（10.3±3.1）d（t=-2.031,P=0.047）。无气腹组住院总费用（6372.8±784.7）元,显著少于气腹组（7984.6±1048.7）元（t=-6.657,P=0.000）。结论无气腹腹腔镜子宫肌瘤剔除术更适于剔除大直径肌瘤,而手术时间与术中出血量未增加,患者术后恢复快,住院时间缩短,住院费用降低,在妇科手术中值得推广。

Comparison of Laparoscopic Myomectomies Using a Subcutaneous Abdominal Wall Lifting Device and Pneumoperitoneum

Objective To evaluate the value of gasless laparoscopic myomectomy （GLM） using a subcutaneous abdominal wall lifting system for leiomyomas. Methods The surgical outcomes, including operation time, intraoperative blood loss, recovery time of gastrointestinal function, hospital stay, complications, and cost of GLM using a subcutaneous abdominal wall lifting system （GLM group） and laparoscopie myomectomy with pneumoperitoneum （LM group） were compared. Results No intra- or postoperative complications occurred in both of the groups. No significant difference was found in the operation time and blood loss between the GLM and LM groups [（99.2±35.4） min vs. （102.7 ±28.8） min, t = -0.411, P=0.682; （77.0±48.3） ml vs. （89.6 ±53.8） ml, t = -0. 940, P = 0. 351 ]. While the GLM group had significantly shorter recovery time of gastrointestinal function and hospital stay [（1.8±0.5） d vs. （2. 1 ±0,3） d, Mann-Whitney U=304.000, P=0.013; and （8.7 ±2.9） d vs. （10.3±3.1） d, t= -2.031, P =0.047], and lower cost [（6372.8±784.7） yuan vs. （7984.6 ±1048.7） yuan,t = -6.657, P =0.000]. Conclusions Since GLM does no results in longer operation time and more blood loss than LM with pneumoperitoneum, it is suitable for large leiomyoma. The patients have quicker recovery, shorter hospital stay, and lower hospital cost after GLM.