垂体后叶素和子宫肌瘤旋切器在卵巢畸胎瘤剔除术中的应用

摘要

Objective To study the application value of pituitrin and morcellation in laparoscopic decollement for mature ovarian teratoma . Methods A total of 86 patients who were diagnosed as having unilateral mature teratoma of the ovary from May 2011 to December 2013 were randomly divided into either experiment group or control group .Pituitrin (3 U +0.9%NS 20 ml) were injected into the cavity between the mature teratoma and the cortex before the decollement and a morcellator knife was used to shatter teratoma in the experiment group , while the control group was given traditional decollement .The operation time, blood loss, rate of teratoma rupture , and ovarian volume were compared between the two groups . Results All of the operations were performed successfully under laparoscope .The operation time of the experiment group and control group was (40 ±26) min and (58 ±25) min (t=3.089, P=0.003), the blood loss was (39 ±16) ml and (68 ±35) ml (t=4.941, P=0.000), and the rate of teratoma rupture was 14.0%(6/43) and 34.9% (15/43) (χ2 =5.103, P=0.024), respectively.The residual volume of the ovary was significantly larger in the experiment group (9.5 ±4.2 cm3 ) than that in the control group (6.5 ±3.1 cm3 , t=3.769, P=0.000) two months after operation.The ovarian volumes were decreased by (2.4 ±1.1) cm3 and (4.2 ±1.8) cm3(t=-5.595,P=0.000) two months after operation . Conclusion Use of pituitrin and morcellation in laparoscopic decollement for mature teratoma of ovary leads to short operation time , less blood loss , low rate of teratoma rupture , and minimal influence of ovarian functions , being superior to regular laparoscopic decollement for mature ovarian teratoma .%目的：探讨垂体后叶素联合10 mm自动子宫肌瘤旋切器在腹腔镜卵巢成熟性畸胎瘤剥除术中的应用价值。方法对我院2011年5月～2013年12月86例育龄期单侧卵巢成熟性畸胎瘤采用随机区组设计方案分成实验组和对照组。对照组采用常规剥除法，实验组将稀释的垂体后叶素（3 U＋0．9％生理盐水20 ml）注入卵巢囊肿壁与皮质间隙后再行剥除，剥离完全后将标本置入标本袋中用10 mm自动子宫肌瘤旋切器将标本旋出。比较2组出血量、手术时间、囊肿破裂率和术后2个月术侧残留卵巢体积。结果2组均在腹腔镜下顺利完成手术。实验组手术时间（40±26） min，明显短于对照组（58±25） min（t＝3．089，P＝0．003）；实验组术中出血量（39±16） ml，明显少于对照组（68±35） ml（t＝4．941，P＝0．000）；实验组囊肿破裂率14．0％（6／43），明显低于对照组34．9％（15／43）（χ2＝5．103，P＝0．024）。术后2个月实验组术侧残留卵巢体积（9．5±4．2） cm3，显著大于对照组手术侧残留卵巢体积（6．5±3．1） cm3（t＝3．769，P＝0．000）；实验组两侧卵巢体积缩小（2．4±1．1） cm3，显著小于对照组两侧卵巢体积的缩小值（4．2±1．8） cm3（t＝－5．595，P＝0．000）。结论腹腔镜下改良卵巢成熟性畸胎瘤剔除术能减少术中出血，降低囊肿破裂率，降低手术难度，减少对卵巢的影响，优于常规腹腔镜卵巢成熟性畸胎瘤剥除术。