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目的:探讨腹腔镜下子宫肌瘤剔除术的手术适应症、手术效果及手术技巧。方法:选择我院2003年1月～2005年5月腹腔镜下子宫肌瘤剔除术93例病例进行回顾性分析。结果:93例手术均获成功,其中单发肌瘤71例,多发性肌瘤22例;肌瘤直径为0.2～14cm;手术缝扎止血21例,其余采用套扎止血和电凝止血;手术时间40～300min,平均(100.54±47.35)min;术中出血量5～600ml,平均(68.28±111.39)ml;术后住院时间4～13d,平均(7.49±1.95)d;无明显并发症。单发肌瘤组手术时间、术中出血量与多发肌瘤组比较均无显著性差异(P均>0.05);壁间深部肌瘤组手术时间、术中出血量均明显多于前壁、后壁肌瘤组(P均<0.01)。后壁肌瘤组术中出血量明显多于前壁肌瘤组(P<0.01),而手术时间无明显差异(P>0.05);肌瘤直径≥6cm组术中出血量多于肌瘤直径<6cm组(P<0.05),而手术时间无明显差异(P>0.05)。结论:腹腔镜下子宫肌瘤剔除术具有微创手术的优点,是有效地保留子宫的手术方法;术中出血量和手术时间主要与肌瘤生长部位及其大小有关。术者娴熟的腹腔镜操作技巧和合理选择适应症是手术成功的关键。
Objective: To investigate the surgical indications, surgical effects and surgical skills of laparoscopic myomectomy. Methods: A retrospective analysis of 93 cases of laparoscopic myomectomy in our hospital from January 2003 to May 2005 was performed. Results: All the 93 surgeries were successful, including 71 cases of single fibroids and 22 cases of multiple myomas. The diameter of fibroids was 0.2 ~ 14 cm. Twenty-one cases were operated on suture and hemostasis. The others were treated by ligation and hemostasis. The average time was 40 to 300 minutes (100.54 ± 47.35) min. The intraoperative blood loss was between 5 and 600 ml (average 68.28 ± 111.39) ml. The postoperative hospital stay was 4 to 13 days (mean, 7.49 ± 1.95) days. There was no obvious complication. There were no significant differences in the operation time, intraoperative blood loss and multiple myoma between the single myoma group (all P> 0.05); the intraoperative deep myometrial tumor operation time, intraoperative bleeding were significantly more than the anterior wall, Posterior wall fibroid group (P <0.01). The bleeding volume in the posterior wall myoma group was significantly more than that in the anterior wall fibroid group (P <0.01), but the operation time was not significantly different (P> 0.05). The bleeding volume in the fibroids ≥ 6cm group was more than that in the fibroids <6cm group (P <0.05), but there was no significant difference in operation time (P> 0.05). Conclusion: Laparoscopic myomectomy has the advantage of minimally invasive surgery, which is an effective method to preserve the uterus. The amount of bleeding and operation time are mainly related to the growth site and size of fibroids. Skilled laparoscopic surgery skills and reasonable choice of indications is the key to the success of the operation.