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目的比较宫腔镜手术与腹腔镜手术治疗较大黏膜下肌瘤的优缺点。方法收集2013年1月至2015年1月在首都医科大学附属北京妇产医院妇科微创中心住院治疗的4~5 cm的Ⅱ型黏膜下肌瘤患者136例的临床资料。年龄25~45岁,平均(34.0±1.3)岁。采用数字表法将全部患者随机分为宫腔镜组和腹腔镜组。宫腔组采用超声监护下宫腔镜下子宫肌瘤剔除术,腹腔组采用腹腔镜下子宫肌瘤剔除术。比较2组患者手术时间、术中出血量、术后抗生素使用天数、平均住院天数,一次性手术完成的病例数、术中出现并发症的病例数。结果宫腔镜组与腹腔镜组比较,手术时间短、术中出血量少,差异有统计学意义(t=11.0162,92.6332;P<0.05);一次性手术成功率腹腔镜组明显高于宫腔镜组,差异有统计学意义(χ~2=4.3590,P<0.05);术中出现并发症者宫腔镜组高于腹腔镜组,差异有统计学意义(χ~2=4.0944,P<0.05);术后抗生素使用天数及平均住院天数,宫腔镜组少于腹腔镜组,差异有统计学意义(t=4.1568,3.4225;P<0.05)。结论宫腔镜手术及腹腔镜手术治疗较大Ⅱ型黏膜下肌瘤均有明确疗效。宫腔镜手术具有手术时间短、术中出血量少、术后恢复快等优势,但与腹腔镜手术相比,其术中并发症较多,腹腔镜手术一次性手术成功率较高。
Objective To compare the advantages and disadvantages of hysteroscopic surgery and laparoscopic surgery for large submucous myoma. Methods The clinical data of 136 patients with type Ⅱ submucosal fibroids from 4 to 5 cm hospitalized in the Department of Gynecology and Minimally Invasive Surgery, Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 2013 to January 2015 were collected. Aged 25 to 45 years old, with an average (34.0 ± 1.3) years. All patients were randomly divided into hysteroscopy group and laparoscopic group using digital table method. The uterine cavity group underwent hysteroscopic uterine myomectomy under ultrasound monitoring, and the abdominal cavity group underwent laparoscopic myomectomy. The operation time, intraoperative blood loss, days of postoperative antibiotic use, average days of hospitalization, the number of cases completed by one-time surgery and the number of complications during operation were compared between the two groups. Results Compared with laparoscopic group, hysterectomy group had shorter operative time and less intraoperative blood loss, the difference was statistically significant (t = 11.0162,92.6332; P <0.05). The success rate of one-time operation in laparoscopic group was significantly higher than that in laparoscopic group There was significant difference between the two groups (χ ~ 2 = 4.3590, P <0.05). Complications were higher in hysteroscopy group than in laparoscopy group (χ ~ 2 = 4.0944, P <0.05). The number of days of antibiotic use and the number of days of hospitalization were shorter in hysteroscopy group than in laparoscopy group (t = 4.1568, 3.4225; P <0.05). Conclusion Hysteroscopic surgery and laparoscopic surgery for greater type Ⅱ submucosal fibroids have a clear effect. Hysteroscopic surgery with short operative time, less blood loss, postoperative recovery and other advantages, but compared with laparoscopic surgery, the more intraoperative complications, laparoscopic surgery, a one-time high success rate of surgery.