阴式和腹腔镜下子宫肌瘤剔除术临床应用分析

摘要

目的：探讨阴式和腹腔镜下子宫肌瘤剔除术两种不同微创手术的临床应用价值。方法回顾性分析2010年1月-2012年12月广西贵港市中西医结合骨科医院收治的36例阴式子宫肌瘤剔除术患者(阴式组)与30例同期腹腔镜下子宫肌瘤剔除术患者(腹腔镜组)的临床资料，并比较两种手术的平均手术时间、平均术中出血量、剔除肌瘤的数目、术后肛门排气时间、平均住院时间、平均住院费用等。结果手术时间：阴式组(90±12.10)min，腹腔镜组(110±10.11)min；术中平均出血量：阴式组(100±12.20)mL，腹腔镜组(200±20.12)mL；剔除肌瘤数：阴式组（4±1.00）个，腹腔镜组（2±1.00）个；住院费用：阴式组（5412±120.12）元，腹腔镜组（7420±200.56）元，两组的手术时间、术中出血量、剔除肌瘤数相比差异有统计学意义(P<0.01)。术后肛门排气时间：阴式组(22±4.15)h，腹腔镜组(24±3.15)h；术后平均住院时间：阴式组(7±2.00)d，腹腔镜组(6±2.00)d，两组术后的肛门排气和平均住院时间相比差异无统计学意义(P＞0.05)。结论阴式手术适合于肌壁间、多发性子宫肌瘤或肌瘤位于子宫下段、子宫后壁的患者。而腹腔镜则适用于盆腔粘连、附件肿块及不孕症探查和肌瘤位于子宫前壁的患者。临床医生应根据自己的技术特长和患者的情况选择恰当的术式。%Objective To explore the clinical value of the differences of two minimally invasive surgery: laparoscopic myomectomy and transvaginalmyomectomy.Methods Retrospective analysis the clinical data of 36 cases of transvaginal myomectomy patients(vaginal group)and 30 cases of laparoscopic myomectomy patients(laparoscopic group) from January 2010 to December 2012 in the hospital, and compare the average of operation time, the average of intraoperative blood loss, the number of the tumors that removed, the postoperative exhausting time, the average hospitalization time, and the average fee of hospitalization time. Results The average operation time of the vaginal group was (90±12.10)min, the average operative time of the laparoscopic group,was (110 ±10.11)min;the mean intraoperative bleeding of vaginal group was (100±12.20)mL, the laparoscopic group was (200±20.12)mL; vaginal remove fibroids (4±1.00), the laparoscopic group remove fibroids (2±1.00); the average cost of hospitalization:the vaginal group was (5412±120.12) yuan the laparoscopic group was (7420 ±200.56) yuan. The compare of the operation time, the mean intraoperative bleeding, the number of fibroids and the cost of the hospitalization of these two guoup were statistically significant (P<0.01). The postoperative anal exhaust time:the vaginal group was (22±4.15)h and the laparoscopic group was (24±3.15)h. The average admission time after operation:the vaginal group was (7±2.00)d and the laparoscopic group, was(6±2.00)d. The compare was not statistically significant (P>0.05). Conclusion Vaginal surgery is suitable for intramural multiple uterine fibroids or myoma in the lower uterine segment, the posterior wall of the uterus of patients. Laparoscopy is applicable to pelvic adhesions, adnexal mass and infertility Profiler, located in the anterior wall of the uterus and fibroids patients. Clinicians should choose the appropriate technique based on their technical expertise and the patient's condition.