子宫大切口、分层缝合方式在腹腔镜下子宫肌瘤剔除术中的应用

摘要

目的 评价子宫大切口、分层缝合方式在腹腔镜下子宫肌瘤剔除术中的价值.方法 选择2010年7月～2011年8月因浆膜下或肌壁间子宫肌瘤需要行子宫肌瘤剔除术并选择腹腔镜手术的88例,均无高血压、哮喘、心肺功能不全及血液系统疾病,按住院日期的单双数分成2组.改良组45例为肌瘤表面大切口、瘤腔分层缝合；常规组43例采用肌瘤表面纵行切口,瘤腔一层连续缝合.2组年龄、肌瘤数目、肌瘤直径、肌瘤的位置、盆腔手术史等方面差异均无显著性(P＞0.05).观察2组手术时间、术中出血量、术后体温≥38℃例数、术后肛门排气时间、住院时间等指标.结果 与常规组相比,改良组手术时间短[(67.9±5.7)min vs.(71.2±6.8)min,t=-2.471,P=0.015],术中出血量少[(56.8±10.3)ml vs.(62.1±12.6)ml,t=-2.165,P=0.033],术后体温≥38℃例数少[5例(11.1％)vs.12例(27.9％),x2=3.980,P=0.046],术后肛门排气时间、术后住院时间差异无显著性(P＞0.05).术后3个月73例复查B超,发现肌瘤改良组5.6％( 2/36),常规组2.7％ (1/37)(x2=0.001,P=0.981).结论 腹腔镜下子宫肌瘤剔除术中,子宫大切口、分层缝合方式技术可行,值得临床推广应用.%Objective To evaluate large incision and multilayer suturing in laparoscopic myomectomy. Methods Selected 88 cases of laparoscopic myomectomy for subserosal or intramural uterine myoma, who received laparoscopic myomectomy from July 2010 to August 2011, were enrolled in this study. None of the patients had hypertension, asthma, cardiopulmonary failure, or blood diseases. The patients were divided into two groups according to the date of hospitalization. Large incision and multilayer suturing was performed on modified group (45 cases) , while longitudinal incision and single layer suturing was used in conventional group (43 cases). No significant difference in the age, number, location, and diameter of the myomas, or history of pelvic surgery was detected between the two groups (P > 0. 05 ). The operation time, intraoperative blood loss, number of patients with postoperative body temperature ≥ 38 ℃ , and postoperative gastrointestinal recovery time and hospital stay were compared between the two groups. Results The modified group showed significantly shorter operation time, less intraoperative blood loss, and fewer cases of postoperative fever than the conventional group [(67.9±5.7) min vs. (71.2±6.8) min, t= -2.471, P=0.015; (56.8±10.3) ml vs. (62.1±12.6) ml, t = -2. 165, P=0.033; body temperature ≥38℃ after the procedure: 5 cases (11.1% ) vs. 12 cases (27.9% ) , x2 =3. 980, P = 0. 046]. However, no significant difference was found between the two groups in the postoperative gastrointestinal recovery time and hospital stay (P > 0.05 ). Totally 73 cases received reexamination by B-ultrasonography in 3 months after the operation, which showed recurrence in 2 patients in the modified group [5.6% (2/36) ] and 1 patients in the conventional group [2.7% (1/37)] (x2 =0.001, P =0.981). Conclusion Large incision and multilayer suturing are feasible for laparoscopic myomectomy.