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目的观察腹腔镜辅助子宫肌瘤剔除术的可行性、安全性及对不孕症患者生殖预后的影响。方法选择单纯子宫浆膜下或肌壁间肌瘤因素引起的不孕患者71例为研究组,同期肌瘤大小、数量、部位相匹配,气腹法腹腔镜手术的72例为对照组。观察两组手术时间、术中出血量、术后恢复、住院天数,术后肌瘤复发、妊娠和分娩的情况。结果两组患者共143例手术均顺利完成,成功率为100%。LAM组患者的手术时间较LM组明显缩短,术中出血量也较少,两组比较差异有显著性(P<0.05)。而术后患者肠功能恢复、平均住院天数两组均相似,差异无显著性(P>0.05)。LAM组妊娠40例(56.3%),自然流产4例(10.0%),早产2例(5.6%),剖宫产24例(66.7%)。LM组妊娠39例(54.2%),自然流产5例(12.8%),早产3例(8.8%),剖宫产25例(73.5%),两组患者妊娠及分娩期均顺利,无子宫破裂发生,相比较差异无显著性(P>0.05)。LAM组的1年、3年和平均肌瘤复发率均明显低于LM组的患者,分别为4.2%(3/71)、11.3%(8/71)、7.0%(5/71)与15.3%(11/72)、25.0%(18/72)、19.4%(14/72),两组相比差异有显著性(P<0.05)。结论腹腔镜辅助子宫肌瘤剔除术可行安全,临床易于操作,微创去除肌瘤后重建的子宫妊娠预后良好,值得在基层医院推广。
Objective To observe the feasibility and safety of laparoscopic assisted myomectomy and its effect on reproductive prognosis of infertile patients. Methods Seventy-one cases of infertility caused by simple uterine myometrial or intramural fibroids were selected as the study group. The size, number and location of fibroids were matched in the same period. 72 cases of laparoscopic pneumoperitoneum were used as the control group. The operation time, intraoperative blood loss, postoperative recovery, hospitalization days, postoperative fibroid recurrence, pregnancy and childbirth were observed. Results A total of 143 procedures were successfully completed in both groups with a success rate of 100%. The operation time of LAM group was significantly shorter than that of LM group, and the amount of bleeding during operation was also lower. There was significant difference between the two groups (P <0.05). The postoperative patients with intestinal function recovery, the average length of stay in both groups were similar, the difference was not significant (P> 0.05). There were 40 pregnancies (56.3%) in LAM group, 4 spontaneous abortions (10.0%), 2 preterm births (5.6%) and 24 cesarean sections (66.7%). There were 39 cases of pregnancy (54.2%) in LM group, 5 cases (12.8%) of spontaneous abortion, 3 cases of premature delivery (8.8%) and 25 cases of cesarean section (73.5%). Occurred, compared with no significant difference (P> 0.05). The 1-year, 3-year and average myoma recurrence rates in LAM group were significantly lower than those in LM group, 4.2% (3/71), 11.3% (8/71), 7.0% (5/71) and 15.3 % (11/72), 25.0% (18/72) and 19.4% (14/72) respectively. There was significant difference between the two groups (P <0.05). Conclusions Laparoscopic assisted uterine myomectomy is feasible and safe, and is clinically easy to operate. The prognosis of uterine pregnancy reconstructed with minimally invasive fibroids is good and worthy of promotion in primary hospitals.