免气腹与气腹腹腔镜下子宫肌瘤切除术的对比分析

摘要

目的通过对免气腹与气腹腔镜下子宫肌瘤切除术的对比分析,探讨免气腹腹腔镜子宫肌瘤切除术的临床应用价值.方法选取2009年1月至2011年3月在我院行免气腹腹腔镜下子宫肌瘤切除术(免气腹组)患者26例,及气腹腹腔镜下子宫肌瘤切除术患者(气腹组)31例进行回顾性对照研究,比较两组手术时间、术中出血量、术后胃肠功能恢复时间、发生并发症情况及住院时间.结果两组手术均在腹腔镜下顺利完成,无中转开腹.免气腹组手术时间明显少于气腹腹腔镜组[(97.6±24.7) min vs (120.9±26.4) min,(P＜0.05)].免气腹组术中出血量[(227.4±84.5) mL vs (339.6±98.7) mL,(P＜0.05)]明显少于气腹组.气腹组术后发生5例皮下气肿,而免气腹组术后无并发症发生,两组比较差异有统计学意义(P＜0.05).结论与气腹腹腔镜子官肌瘤切除相比,免气腹法具有手术时间短、术中出血少、手术操作简便、术后并发症少,对患者循环呼吸影响小等优点,值得推广应用.但其对术后再次妊娠的影响有待于进一步研究.%Objective To evaluate the gasless laparoscopic myomectomy by comparison of it with pneumo-peritoneal laparoscopic myomectomy. Methods The retrospective analysis was made on 26 cases treated with gasless laparoscopic myomectomy and 31 cases treated with laparoscopic myomectomy from Jan. 2009 to Mar.2011, the operating time,intra-operative blood loss, the first anal deflation time the postoperative complication and hospitalization time were compared between the two groups. Results The two groups of laparoscopic operation were completed successfully without second laparotomy. The operative time of gasless laparoscopic myomectomy group was shorter than that of laparoscopic myomectomy group[ ( 97.6 ± 24.7 ) min vs ( 120.9 ± 26.4 )min,( P ＜ 0.05 ) ]. The blood loss of gasless laparoscopic myomectomy group ]was less than that of laparoscopic myomectomy group[ ( 227.4 ± 84.5 ) mL vs ( 339.6 ± 98.7 ) mL ,( P ＜ 0.05 ) ]. There were five cases of subcutaneous emphysema in laparoscopic myomectomy group, none in gasless laparoscopic myomectomy group.Conclusion Compared with the traditional laparoscopic myomectomy,gasless laparoscopic myomectomy has the advantages of shorter operating time, less blood loss, esaier operation,less postoperative complications, less influence on circulatory and respiratory system, which deserves recommendation to patients with myoma, while the influence on pregnancy after the operation needs further studies.