摘要
目的 评估采用腹腔镜辅助下腹壁小切口行肌壁间子宫肌瘤切除术 (LAM)的可行性和安全性。方法 对 37例肌壁间子宫肌瘤患者采用LAM ,肌瘤直径均 >5cm ,<9cm ;其中 2例肌瘤深达宫腔 (肌瘤深入宫腔均 <5 0 % )。选择同期作开腹手术的 35例子宫肌瘤患者作对照组。所有LAM在腹腔镜辅助下完成。一半肌瘤剥离后扩大腹壁正中辅助穿刺点切口至 4～ 5cm长 ,在腹壁切口外完成整个肌瘤剥离术及子宫创面的缝合。临床观察指标包括手术时间 ,术中出血量 ,术中和术后并发症及术后恢复时间 (起床及排气时间 ) ;并与同等条件同期开腹行肌瘤切除术者相比较。结果 LAM组手术所需时间为 10 1min± 5 6min ,与对照组手术所需时间 89min± 38min比较 ,差异无显著意义 ,P>0 .0 5。术中出血量 (中位数 )LAM组为 5 0ml,对照组为 80ml,两者比较 ,P <0 .0 5。LAM组术后病率2 7% (1/ 37) ,对照组为 6 3% (2 2 / 35 ) ,两组比较P <0 0 0 1;术后起床及排气时间LAM组明显早于对照组 ,P <0 .0 0 1。LAM组术中术后无一例出现并发症。 11例不孕症行LAM 1年后有 8例妊娠 ,妊娠进展顺利直至孕 37～ 38周剖宫产。结论 LAM是一种安全可行的技术 ,该技术提供了一种易于操作及损伤最小的切除子宫肌壁间肌瘤之技术 ;它保留了腹腔镜手术的优点 ,
Objective To evaluate the feasibility and safety of laparoscopically assisted myomectomy (LAM) for uterine intramural fibroids. Methods Thirty seven selected patients with uterine intramural fibroids with the diameters >5 cm and <9 cm were subjected to LAM technique, the intramural fibroid of 2 among which penetrated into the uterine cavity (<50%). LAM was completed with a laparoscopically assisted enucleation After the fibroid was half scripped, the incision of puncture point at the middle of abdominal wall was expanded to 4～5 cm in length. The scripping of the fibroid and the suture of the uterine wound were completed outside the abdominal incision. The duration of operation, blood loss, intra and post operation complications and time to full recovery were evaluated and comparison with those in 630 patients with hysteromyoama who underwent myomectomy by laparotomy during the same period. Results The operative time in LAM group ranged from 50 min to 240 min (101 min±56 min), without a significant difference in comparison with that in the group of myomectomy by laparotomy (89 min±38 min, P >0.05). However, the median of blood loss in LAM group was 50 ml, significantly less than that in the group of myomectomy by laparotomy (80 ml, P <0.05). The incidence of pyrexia was lower and the time needed for recovery was shorter after LAM in comparison with those in the group of myomectomy by laparotomy ( P <0.001). Neither intra operative nor post operative complication was observed in the LAM group. Eight of the 11 cases with infertility in the LAM group were conceived at least one year after LAM. The pregnancy was uneventful and proceeded to cesarean section at the 37～38 th week. Conclusion LAM operation is feasible and safe, and offers a easy to perform minimally invasive myomectomy technique for intramural fibroid removal with all the advantages of laparoscopic surgery and a good reconstructive outcome.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2002年第13期883-886,共4页
National Medical Journal of China
