改良悬吊式腹腔镜子宫肌瘤切除术38例临床研究.doc

改良悬吊式腹腔镜子宫肌瘤切除术38例临床研究[摘要] 目的 探讨改良悬吊式腹腔镜子宫肌瘤切除术的应用价值。方法 2006年1月～2009年6月实施改良悬吊式腹腔镜子宫肌瘤切除术38例患者的临床资料,并在同期使用气腹式腹腔镜子宫肌瘤切除术32例作为对照。结果 悬吊组均在镜下完成,气腹组1例中转开腹。悬吊式组在平均手术时间、术中出血量和术后疼痛发生率方面均优于气腹组,差异有统计学意义。在术后体温恢复正常时间、肛门排气时间方面无统计学差异。术后8例出现9次术后妊娠,其中两例有生育要求者成功妊娠至晚期行剖宫产手术分娩。结论 改良悬吊式腹腔镜子宫肌瘤切除术是一种较好的治疗妇科疾病的微创技术,可能会成为子宫肌瘤手术治疗的标准术式。 [关键词] 子宫肌瘤切除术; 改良悬吊式腹腔镜; 微创手术 [中图分类号] R733.33 [文献标识码] A [文章编号] 1673-9701(2010)05-106-03 Study of Improved Gasless Laparoscopic Technique in Myomectomy MA Dan XUE Yan Department of Gynaecologics and Obstetrics,Dalian Central Hospital,Dalian 116033,China [Abstract] ObjectiveTo compare the feasibility,safety,reliability and postoperative outcomes of myomectomy performed by improved gasless laparoscopy and conventional laparoscopy. MethodsSeventy women with symptomatic uterine myomas were divided into improved gasless laparoscopy group(n=38)and conventional laparoscopy group(n=32). ResultsCompared with conventional laparoscopic myomectomy,improved gasless laparoscopy resulted in less intra-operative and postoperative blood loss,shorter operating time and less incidence of postoperative pain.However time for body temperature recovery and anal exsufflation time discharge time had no significantly differences between two groups. Eight patients had nine postoperative pregnancies and two of them had cesarean section in late pregnancy. ConclusionImproved gasless laparoscopic myomectomy exhibits more advantages than the conventional laparoscopy,and may become the standard mymectomy. [Key word]Uterine myomectomy; Improved gasless laparoscopy 子宫肌瘤切除术不仅保留了患者的生育能力,更重要的是维持了子宫的生理功能,保持了盆底结构的完整性,有利于患者术后的身心康复。腹腔镜子宫肌瘤切除术以患者创伤小、康复快等优势越来越得到医师和患者的认可。但传统腹腔镜手术需要在气腹下进行手术,须全麻且腔镜手术器械使手术成本提高。近年来,国外一些妇科腹腔镜手术专家开展了悬吊式腹腔镜手术(gasless laparoscopic surgery using the abdominal wall lifting,AWL)。悬吊式无需气腹,麻醉时循环系统和呼吸系统也基本不受影响,手术的安全性提高。我院进行改良悬吊式腹腔镜手术结合了气腹与悬吊两者之优点,在低压气腹下快速进入腹腔,简化操作口的处理,在悬吊状态下进行肌瘤切除,手术方法与开腹相似,简便易行。我院于2006年1月～2009年6月共开展改良悬吊腹腔镜子宫肌瘤切除手术38例,效果良好,现报道如下。 1 资料与方法