中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2011年
9期
669-673
,共5页
李孟慧%冷金花%史精华%贾双征%郎景和
李孟慧%冷金花%史精華%賈雙徵%郎景和
리맹혜%랭금화%사정화%가쌍정%랑경화
子宫肿瘤%平滑肌瘤%腹腔镜检查%肿瘤,残余%肿瘤复发,局部%妊娠结局
子宮腫瘤%平滑肌瘤%腹腔鏡檢查%腫瘤,殘餘%腫瘤複髮,跼部%妊娠結跼
자궁종류%평활기류%복강경검사%종류,잔여%종류복발,국부%임신결국
Uterine neoplasms%Leiomyoma%Laparoscopy%Neoplasm,residual%Neoplasm recurrence,local%Pregnancy outcome
目的：比较子宫肌瘤患者腹腔镜与开腹子宫肌瘤剔除术的手术学特点、术后肌瘤残留、复发情况及妊娠结局。方法 回顾性分析2008年1月至12月在北京协和医院同期行腹腔镜或开腹子宫肌瘤剔除术461例患者的临床资料，腹腔镜313例、开腹148例，比较其一般情况、围手术期特点、术后残留、复发及妊娠结局。结果开腹患者剔除最大肌瘤直径(7.6±3.0) cm、剔除肌瘤数目(5.6±5.5)个、剔除肌瘤重量(308 ±364)g均高于腹腔镜患者[分别为(6.8±2.0) cm、(2.4±2.1)个、(140±109)g]，分别比较，差异均有统计学意义(P＜0.01)。与腹腔镜患者相比，开腹患者的手术时间长[分别为(74 ±35)、(89±32) min]、术中失血量增多[分别为(149±252)、(239±251)ml]、围手术期血红蛋白含量降低程度增大[分别为(15±12)、(22±14) g/L]、术后住院时间增加[分别为(4.4±1.3)、(6.4±1.6)d]，分别比较，差异均有统计学意义(P＜0.01)。然而，腹腔镜与开腹患者术后残留率（分别为2.6％、1.4％）、复发率（分别为11.1％、12.3％）、术后妊娠率(分别为49.2％、9/13)比较，差异均无统计学意义（P＞0.05）。肌瘤数目是影响复发的主要因素（OR=2.805，95％CI为1.192 ～6.601，P=0.0180）。所有术后妊娠患者均未发生妊娠中子宫破裂。结论腹腔镜与开腹子宫肌瘤剔除术是有生育要求或要求保留子宫患者的有效、安全的治疗方式。大部分的子宫肌瘤手术可以通过腹腔镜完成。腹腔镜子宫肌瘤剔除术的术后残留率高于开腹术式，但术后短期复发率相近。多发肌瘤是复发的主要危险因素；肌瘤数目≥4个者腹腔镜子宫肌瘤剔除术后复发率增加。腹腔镜与开腹子宫肌瘤剔除术后妊娠率相当。
目的：比較子宮肌瘤患者腹腔鏡與開腹子宮肌瘤剔除術的手術學特點、術後肌瘤殘留、複髮情況及妊娠結跼。方法 迴顧性分析2008年1月至12月在北京協和醫院同期行腹腔鏡或開腹子宮肌瘤剔除術461例患者的臨床資料，腹腔鏡313例、開腹148例，比較其一般情況、圍手術期特點、術後殘留、複髮及妊娠結跼。結果開腹患者剔除最大肌瘤直徑(7.6±3.0) cm、剔除肌瘤數目(5.6±5.5)箇、剔除肌瘤重量(308 ±364)g均高于腹腔鏡患者[分彆為(6.8±2.0) cm、(2.4±2.1)箇、(140±109)g]，分彆比較，差異均有統計學意義(P＜0.01)。與腹腔鏡患者相比，開腹患者的手術時間長[分彆為(74 ±35)、(89±32) min]、術中失血量增多[分彆為(149±252)、(239±251)ml]、圍手術期血紅蛋白含量降低程度增大[分彆為(15±12)、(22±14) g/L]、術後住院時間增加[分彆為(4.4±1.3)、(6.4±1.6)d]，分彆比較，差異均有統計學意義(P＜0.01)。然而，腹腔鏡與開腹患者術後殘留率（分彆為2.6％、1.4％）、複髮率（分彆為11.1％、12.3％）、術後妊娠率(分彆為49.2％、9/13)比較，差異均無統計學意義（P＞0.05）。肌瘤數目是影響複髮的主要因素（OR=2.805，95％CI為1.192 ～6.601，P=0.0180）。所有術後妊娠患者均未髮生妊娠中子宮破裂。結論腹腔鏡與開腹子宮肌瘤剔除術是有生育要求或要求保留子宮患者的有效、安全的治療方式。大部分的子宮肌瘤手術可以通過腹腔鏡完成。腹腔鏡子宮肌瘤剔除術的術後殘留率高于開腹術式，但術後短期複髮率相近。多髮肌瘤是複髮的主要危險因素；肌瘤數目≥4箇者腹腔鏡子宮肌瘤剔除術後複髮率增加。腹腔鏡與開腹子宮肌瘤剔除術後妊娠率相噹。
목적：비교자궁기류환자복강경여개복자궁기류척제술적수술학특점、술후기류잔류、복발정황급임신결국。방법 회고성분석2008년1월지12월재북경협화의원동기행복강경혹개복자궁기류척제술461례환자적림상자료，복강경313례、개복148례，비교기일반정황、위수술기특점、술후잔류、복발급임신결국。결과개복환자척제최대기류직경(7.6±3.0) cm、척제기류수목(5.6±5.5)개、척제기류중량(308 ±364)g균고우복강경환자[분별위(6.8±2.0) cm、(2.4±2.1)개、(140±109)g]，분별비교，차이균유통계학의의(P＜0.01)。여복강경환자상비，개복환자적수술시간장[분별위(74 ±35)、(89±32) min]、술중실혈량증다[분별위(149±252)、(239±251)ml]、위수술기혈홍단백함량강저정도증대[분별위(15±12)、(22±14) g/L]、술후주원시간증가[분별위(4.4±1.3)、(6.4±1.6)d]，분별비교，차이균유통계학의의(P＜0.01)。연이，복강경여개복환자술후잔류솔（분별위2.6％、1.4％）、복발솔（분별위11.1％、12.3％）、술후임신솔(분별위49.2％、9/13)비교，차이균무통계학의의（P＞0.05）。기류수목시영향복발적주요인소（OR=2.805，95％CI위1.192 ～6.601，P=0.0180）。소유술후임신환자균미발생임신중자궁파렬。결론복강경여개복자궁기류척제술시유생육요구혹요구보류자궁환자적유효、안전적치료방식。대부분적자궁기류수술가이통과복강경완성。복강경자궁기류척제술적술후잔류솔고우개복술식，단술후단기복발솔상근。다발기류시복발적주요위험인소；기류수목≥4개자복강경자궁기류척제술후복발솔증가。복강경여개복자궁기류척제술후임신솔상당。
Objectives To compare operative characteristics, postoperative residue, recurrence, and pregnancy outcome between laparoscopic myomectomy (LM) and transabdominal myomectomy (TAM),and investigate the favourable surgical approach in women with uterine myomas. Methods From Jan 2008 to Dec 2008, 313 women undergoing LM and 148 women undergoing TAM were studied retrospectively in Peking Union Medical College Hospital. The patients' general information, including the largest diameter,mean numbers and weights of excised myomas, peri-operative characteristics (operating time, blood loss,and hemoglobin decrease), and residue, recurrence of myoma, and pregnancy outcome were compared and analyzed. Results The largest diameter, mean numbers and mean weight of myomas removed were larger in TAM group [( 7.6 ± 3.0) cm, (5.6 ± 5.5 ), ( 308 ± 364) g, respectively]than those in LM group [(6.8±2.0) cm, (2.4 ±2.1), (140 ± 109) g, respectively; P＜0.01]. While the extension of operating time [(89±32) versus (74 ±35) min], increased blood loss [(239 ±251 ) versus ( 149 ±252) ml]and hemoglobin decrease [(22 ± 14) versus ( 15 ± 12) g/L], and longer hospital stay [(6. 4 ± 1. 6)versus (4. 4 ± 1.3) d]were observed in TAM group when compared with those in LM group ( P ＜0. 01 ).However, the residue rate of LM and TAM was 2. 6％ versus 1.4％ respectively ( P = 0. 5130 ) ; the recurrence rate of LM and TAM was 11.1％ versus 12. 3％ (P ＞ 0. 05 ) ; the pregnancy rate of LM and TAM was 49. 2％ versus 9/13 separately, the difference was not statistically significant ( P = 0. 2330 ). The number of myomas removed was the significant risk factors associated with recurrence ( OR = 2. 805, 95％CI: 1. 192 -6. 601, P = 0. 0180). No uterine rapture occurred during pregnancy. Conclusions Both LM and TAM are effective surgical approaches for the patients with leiomyoma who desire to pregnancy, or to retain the integrity of their uteruses. Most of uterine myoma could be treated through laparoscopy. The residue rate of LM is higher than that of TAM. However, the short term recurrence rates of LM and TAM are similar. Multiple myomas is the risk factor associated with recurrence after myomectomy. The pregnancy rates are comparable between LM and TAM groups.
