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目的比较经阴道子宫肌瘤剔除术(TVM)及腹腔镜子宫肌瘤剔除术(LM)治疗子宫肌瘤的疗效。方法选取2012年3月-2015年3月在吉林大学中日联谊医院妇产科就诊,符合手术条件的300例子宫肌瘤患者,随机分为LM组和TVM组,每组各150例患者。比较两组患者的手术时间、术中出血量、剔除子宫肌瘤个数及最大直径、术后留院时间、术后排气时间。结果 LM组除两例患者因肌壁间肌瘤缝合困难而转开腹手术外,另外148例患者均手术成功。TVM组患者均手术成功。两组术中出血量及剔除子宫肌瘤个数比较,差异均有统计学意义(均P<0.05);两组手术时间及剔除子宫肌瘤的最大直径比较差异均无统计学意义(均P>0.05)。术后,两组患者均未出现复发。两组术后排气时间及术后留院时间比较差异均无统计学意义(均P>0.05)。结论与LM相比,TVM的术中出血量少,剔除子宫肌瘤数量多,非常适合剔除肌壁间或较深部位的子宫肌瘤。LM则具有伤害小、术后不易发生粘连等优势。因此,手术医师要根据自身对某一术式的熟练程度和患者的客观病情来决定应用哪种手术方式最合适。
Objective To compare the efficacy of vaginal myomectomy (TVM) and laparoscopic myomectomy (LM) in the treatment of uterine fibroids. Methods From March 2012 to March 2015, 300 patients with uterine leiomyoma who were treated in Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Jilin University, were randomly divided into LM group and TVM group, with 150 cases in each group. The operation time, intraoperative blood loss, the number of uterine fibroids and the maximum diameter, postoperative hospital stay and postoperative exhaust time were compared between the two groups. Results In the LM group, the other 148 patients were successfully operated except two patients who underwent open surgery due to the difficulties of suture of the muscular intramural fibroids. TVM patients were successful in surgery. There was no significant difference between the two groups in the amount of bleeding during operation and the number of uterine fibroids (all P <0.05). There was no significant difference in the operative time and the maximum diameter of uterine fibroids > 0.05). No postoperative recurrence occurred in both groups. There was no significant difference in postoperative exhaust time and postoperative hospital stay between the two groups (all P> 0.05). Conclusion Compared with LM, TVM less intraoperative blood loss, excluding a large number of uterine fibroids, very suitable for the removal of intramural or deeper uterine fibroids. LM is less harmful, less prone to adhesions and other advantages. Therefore, the surgeon according to their proficiency in a particular operation and the patient’s objective condition to decide which surgical approach is most appropriate.