Quill缝线在腹腔镜下子宫肌瘤剔除术中的应用效果

摘要

目的：探讨Quill缝线在腹腔镜下子宫肌瘤剔除术中的应用效果。方法2012年3~6月我院103例大子宫肌瘤(直径8~12 cm)在腹腔镜下行子宫肌瘤剔除术,52例应用Quill缝线缝合子宫肌瘤残腔( Quill线组),51例应用薇乔线缝合肌瘤残腔(薇乔线组),比较2组患者术中、术后情况及预后。结果 Quill线组缝合子宫时间(8.7±1.9)min,明显短于薇乔线组(17.4±3.2)min(t=-16.815,P=0.000)；Quill线组手术时间(77.2±8.2) min,明显短于薇乔线组(91.8±14.0) min(t=-6.473,P=0.000)；Quill线组留置盆腔引流时间(28.0±3.9)h,明显短于薇乔线组(41.1±7.1)h (t=-11.636,P=0.000)；Quill线组术中出血量(88.4±11.6)ml,明显少于薇乔线组(112.9±20.9)ml(t=-7.374,P=0.000)；Quill线组术后病率11.5%(6/52),明显低于薇乔线组27.4%(14/51)(χ2=4.167,P=0.041)；Quill线组术后住院时间(3.5 ± 0.5)d,明显短于薇乔线组(3. 8± 0.6)d,(t=-2.759,P=0.007)。术后随访2年：2组术后1、2年子宫肌瘤复发率和妊娠率比较差异均无统计学意义(P>0.05)。结论腹腔镜下子宫肌瘤剔除术中应用Quill缝线缝合肌瘤残腔可以降低手术难度,明显减少术中出血量,缩短缝合时间,有利于患者术后恢复,尤其适用于大子宫肌瘤(8~12 cm)缝合残腔,值得推广应用。%Objective To evaluate clinical effects of the Quill thread in laparoscopic hysteromyomectomy. Methods A retrospective study was conducted on 103 patients with uterine leiomyoma undergoing laparoscopic hysteromyomectomy from March to June 2012. The patients were divided into two groups:52 cases underwent laparoscopic intramural myomectomy with continous suture with Quill thread ( Quill group ); 51 cases underwent laparoscopic intramural myomectomy with interrupted suture by Vicryl thread (Vicryl group). The operative situation and long-term prognosis were compared between the two groups. Results The time for closing uterine wall defects was (8. 7 ± 1. 9) min in the Quill group, which was significantly shorter than that in the Vicryl group (91. 8 ±14. 0) min (t= -6. 473, P=0. 000). Moreover, as compared with the Vicryl group, the Quill group had significantly shorter operation time [(77. 2 ± 8. 2) min vs. (91. 8 ± 14. 0) min, t = -6. 473, P =0. 000], shorter drainage indwelling time [(28. 0 ± 3. 9) h vs. (41. 1 ± 7. 1) h, t= -11. 636, P=0. 000], less intraoperative blood loss [(88. 4 ± 11. 6) ml vs. (112. 9 ± 20. 9) ml; t = -7. 374, P =0. 000], lower postoperative morbidity [11. 5% (6/52) vs. 27. 4% (14/51), χ2 =4. 167, P =0. 041], and shorter postoperative hospital stay [(3. 5 ± 0. 5)d vs. (3. 8 ± 0. 6) d, t= -2. 759, P=0. 007]. The two groups were followed up for 2 years, during which no significant difference was found in pregnancy rate and recurrence rate between the two groups (P>0. 05). Conclusions As compared with Vicryl thread interrupted suture, use of Quill thread continuous suture in laparoscopic intramural myomectomy has characteristics of easier performance, shorter time of suture, less intraoperative blood loss, and faster postoperative rescovery, especially suitable for large uterine leiomyoma ( ranged from 8 to 12 cm) . It is worthy of popularization.