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目的:探讨阴式下进行复杂子宫肌瘤剔除术的可行性。方法:对83例多发、肌瘤较大、多部位的肌瘤(即复杂子宫肌瘤)患者在阴道行子宫肌瘤剔除术,观察手术并发症、手术时间、术中出血量及术后恢复情况。其中多发性子宫肌瘤(肌瘤≥4个)者36例,单发子宫肌瘤直径≥8 cm者32例(肌壁间肌瘤20例,子宫浆膜下肌瘤12例),子宫阔韧带肌瘤5例,宫颈肌瘤10例。剔除子宫肌瘤最多达8个,子宫肌瘤直径≥12 cm者22例,其中直径最大的达到13.4 cm(为宫颈部向左突出的阔韧带肌瘤,重1 950 g)。结果:所有病例手术均获成功,无一例转开腹,也无手术中并发症发生。平均手术时间(75±26)m in,平均术中出血量(125±33)m l,术后平均住院时间4天。子宫多发性肌瘤、肌壁间肌瘤术中出血量及手术时间明显多于宫颈肌瘤,阔韧带肌瘤及浆膜下肌瘤,差异有统计学意义(P<0.05)。10例未产妇分别在6~12个月妊娠,足月产8例,2例分别是孕35周先兆子宫破裂行剖宫产,另1例孕36周胎儿宫内窘迫剖宫产手术。手术无年龄限制。结论:复杂子宫肌瘤剔除术可在阴道完成。手术器械、熟练的手术技巧是手术成功的关键。
Objective: To explore the feasibility of vaginal complex myomectomy. Methods: Eighty-three patients with multiple fibroids, multiple myomas (complex uterine fibroids) underwent vaginal myomectomy. Observe the complications, operation time, intraoperative blood loss and postoperative recovery Happening. Of which 36 cases of multiple uterine fibroids (fibroids ≥ 4) in 36 cases, single uterine fibroids ≥ 8 cm diameter 32 cases (20 cases of intramural fibroids, uterine fibroids in 12 cases), uterine wide 5 cases of ligament fibroids, 10 cases of cervical fibroids. Excluding uterine fibroids up to 8, uterine fibroids ≥ 12 cm in diameter 22 cases, of which the largest diameter of 13.4 cm (for the cervix to the left prominent broad ligament fibroids, weight 1 950 g). Results: All cases were successful in operation, none of them turned to open surgery and no complications occurred. The average operation time was (75 ± 26) mins, the average blood loss (125 ± 33) m l, the average postoperative hospital stay was 4 days. Uterine multiple myoma, intramural fibroids intraoperative bleeding and operation time was significantly more than cervical myoma, broad ligament fibroids and subserosal fibroids, the difference was statistically significant (P <0.05). 10 cases of non-mothers were 6 to 12 months of pregnancy, full-term 8 cases, 2 cases were 35 weeks pregnant rupture of threatened uterine rupture cesarean section, another 1 case of 36 weeks of fetal distress cesarean section. No age limit surgery. Conclusion: Complex myomectomy can be done in the vagina. Surgical instruments, skilled surgical skills is the key to successful operation.