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目的研究腹腔镜下假包膜内子宫肌瘤剔除术的预后及对生育结局的影响。方法对2011年7月-2015年9月该院收治的337例子宫肌瘤患者进行回顾分析,均采取腹腔镜辅助下实施假包膜内子宫肌瘤剔除术,追踪随访观察6~48个月,评估患者预后效果,重点记录部分生育需求者最终妊娠结局情况。结果手术耗时平均(97.34±24.67)min,出血量(124.51±19.55)ml;均在术后给予抗生素用药,未发生感染肠道损伤等并发症;279例患者于术后2 d内出院;7例患者因肌瘤复发采取二次腹腔镜下子宫肌瘤剔除术。315例(93.47%)患者盆腔疼痛症状明显缓解,仅2例患者因盆腔持续疼痛,且镇痛处理后仍伴有复发迹象,后期转行子宫切除;通过对有生育需求的149例(71例多发肌瘤、78例单发肌瘤)患者追踪观察,其中106例患者成功妊娠并完成分娩,未发生子宫破裂,新生儿Apgar评分为(9.08±0.61)分,新生儿体重(3 165±275)g。结论采取腹腔镜下假包膜内子宫肌瘤剔除术进行子宫肌瘤的治疗具有操作简便、耗时短、并发症发生率低,手术安全性高等优势,而假包膜的完整保留可减少神经血管损伤程度,降低病灶组织肌层损伤,提高患者后期子宫肌层创口愈合,确保生理功能的完整性,提高患者妊娠成功率,改善生育质量。
Objective To study the prognosis of laparoscopic pseudomembranous myomectomy and its effect on reproductive outcome. Methods From July 2011 to September 2015, 337 cases of uterine leiomyoma admitted to our hospital were retrospectively analyzed. Laparoscopic resection of pseudomembranous myomectomy was performed. The patients were followed up for 6 to 48 months , To assess the prognosis of patients, focusing on the record part of the fertility needs of the final pregnancy outcome. Results The operation time was averagely (97.34 ± 24.67) min and the amount of bleeding was (124.51 ± 19.55) ml. All patients were given antibiotics after operation and no complications such as intestinal injury were found. 279 patients were discharged within 2 days after operation. Seven patients had recurrent laparoscopic myomectomy due to myoma recurrence. The pelvic pain symptoms were relieved in 315 cases (93.47%). Only 2 patients continued to have pain due to pelvic obstruction and remained relapsed after the analgesic treatment. The hysterectomy was performed in the later period. Fibroids and 78 cases of single myoma were followed up. Among them, 106 cases were successful in pregnancy and delivery was completed without rupture of the uterus. Apgar score (9.08 ± 0.61), newborn weight (3 165 ± 275) g. Conclusion Laparoscopic pseudomembranous myomectomy for the treatment of uterine fibroids has the advantages of simple operation, short time, low complication rate and high operative safety. The intact pseudocapsule can reduce the number of nerves Vascular injury, reduce the damage to the myometrium of the lesion tissue, improve the wound healing of the myometrium in the late stage, ensure the integrity of physiological functions, improve the success rate of pregnancy and improve the quality of childbirth.