国际妇产科学杂志

国际妇产科学杂志 ›› 2014, Vol. 41 ›› Issue (5): 522-525.

• 论著 • 上一篇    下一篇

宫腔镜与腹腔镜手术剔除子宫壁间肌瘤临床分析

申爱荣，邹顺鸿   

  1. 450052 郑州大学第三附属医院
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2014-10-15 发布日期:2014-10-15

The Comparative Study between Transcervical Resection of Myoma and Laparoscopic Myomectomy of Intramural Uterine Myoma

HEN Ai-rong，ZOU Shun-hong   

  1. The Third Affiliated Hospital of Zhengzhou University，Zhengzhou 450052，China
  • Received:1900-01-01 Revised:1900-01-01 Published:2014-10-15 Online:2014-10-15

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摘要： 目的：探讨宫腔镜下子宫肌瘤电切术（TCRM）和腹腔镜下子宫肌瘤剔除术（LM）的围手术期指标、术后子宫肌层愈合情况及对妊娠的影响，从而为子宫壁间肌瘤内镜手术方式的选择提供依据。方法：回顾性分析在2007年1月1日—2011年12月31日行TCRM和LM患者的临床资料，宫腔镜组236例、腹腔镜组392例，比较2组的一般情况、围手术期特点、术后肌层愈合情况及妊娠结局。结果：2组患者平均手术时间、术中出血量和围手术期血红蛋白减低程度比较，宫腔镜组均少于腹腔镜组，差异有统计学意义（均P＜0.05），术中转开腹率、术后发热率和术后月经改善率比较差异无统计学意义（均P＞0.05）。在随访的181例宫腔镜组患者和336例腹腔镜组患者中，术后1，3，6个月的肌层完全愈合率宫腔镜组均高于腹腔镜组，差异有统计学意义（均P＜0.05），术后12个月肌层完全愈合率差异无统计学意义（P=0.709）。宫腔镜组首次妊娠距肌瘤剔除术的时间短于腹腔镜组，差异有统计学意义（P＜0.05）。所有术后妊娠患者均未发生妊娠期子宫破裂。结论：TCRM与LM均安全可靠，TCRM术中出血少、术后恢复快，对有生育要求的患者，TCRM优于LM。

关键词: 宫腔镜, 腹腔镜, 肌瘤, 平滑肌瘤, 子宫, 外科手术, 微创性, 子宫壁间肌瘤

Abstract: Objective：To compare the clinic value between the transcervical resection of myoma （TCRM） and laparoscopic myomectomy （LM）, and investigate the favourable surgical approaches in women with intramural uterine myomas. Methods：From January 1, 2007 to December 31, 2011, 236 women undergoing TCRM （hysteroscopy group） and 392 women undergoing LM （laparoscope group） were studied retrospectively in The Third Affiliated Hospital of Zhengzhou University. The patients′ general information, peri-operative characteristics, postoperative muscle healing, and pregnancy outcome were compared and analyzed. Results：The average operation time, the average intraoperative blood loss and the reduce perioperative hemoglobin level of hysteroscopic group and laparoscopic group were compared respectively, the difference had statistical significance （P＜0.05）. The transfer laparotomy operation rate, postoperative fever rate and menstrual period rate of hysteroscopic group and laparoscopic group were compared. There was no significant difference （P＞0.05）. In the follow-up of 181 cases of hysteroscopy group and 336 cases of laparoscopic group of patients, the muscular complete healing rate of postoperative 1 month, 3 months, 6 months were respectively comparison, the difference had statistical significance （P＜0.05）. The muscular complete healing rate of postoperative 12 months was no statistically significant difference （P=0.709）. The postoperative pregnancy from fibroids weed out of time for the first time of hysteroscopic group and laparoscopic group was statistically significant difference （P＜0.05）. All patients with postoperative pregnancy appeared no pregnant uterine rupture. Conclusions：For intramural myoma, two kinds of operation modes are safe and reliable. The intraoperative bleeding and postoperative recovery by TCRM is better than the patientes treated by LM, so hysteroscopy surgery is superior to the laparoscopic surgery for the patients with intramural uterine myoma.

Key words: Hysteroscopes, Laparoscopes, Myoma, Leiomyoma, Uterus, Surgical procedures, Intramural uterine myoma