腹腔镜下多发子宫肌瘤剔除术临床疗效分析

摘要

Objective To investigate the clinical efficacy of laparoscopic myomectomy (LM) for women with multiple uterine myomas.Methods We retrospectively analyzed 476 patients with multiple uterine myomas in our hospital from January 2013 to December 2014.Of these patients,297 patients were treated with LM while another 179 patients were treated with transabdominal myomectomy (TAM).A series of intraoperative and postoperative data were compared between the two groups.Results The LM group had less operation time,less intraopertaive blood loss,lower ratio of analgesia use,quicker recovery of bowel function,shorter hospital stay and less complications when compared to the TAM group (P ＜0.05).There was no significant difference in the recurrence rate between the two groups within 12 months after operation (P ＞ 0.05).However,the recurrence rate in LM group were higher than TAM group within 24 months after operation (P ＜ 0.05).Conclusion Compared with TAM,LM has obvious advantage such as less iatrogenicinjury,less bleeding,less complications and quicker recovery.It is worthy of clinical promotion.However,the long-term recurrence rate in LM was higher than that in TAM.Therefore,LM should be applied with caution,especially when the patients have birth request.%目的 探讨腹腔镜下多发性子宫肌瘤剔除术的临床疗效与应用价值.方法 回顾性分析2013年1月至2014年12于四川大学华西第二医院收治的476例多发性子宫肌瘤患者.其中腹腔镜下子宫肌瘤剔除术297例(腹腔镜组),经腹子宫肌瘤剔除术179例(开腹组),比较两组术中术后情况及随访情况.结果 腹腔镜组患者的手术时间、术中出血量、术后镇痛药物使用率、肛门排气时间、术后住院时间及术后并发症发生率均明显少于开腹组,差异有统计学意义(P＜0.05).两组患者术后12月肌瘤复发率差异无统计学意义(P＞0.05).术后24月随访腹腔镜组患者的肌瘤复发率明显高于开腹组,差异有统计学意义(P＜0.05).结论 与开腹手术相比,腹腔镜下多发子宫肌瘤剔除术具有手术创伤小、术中出血少、术后并发症少、恢复快等优势,值得临床推广,但肌瘤复发率高于开腹手术,对于有生育要求患者应权衡利弊.