CAJ | 학술논문

目的：比较腹腔镜下子宫肌瘤剔除术（laparoscopic myomectomy ，LM）、子宫动脉栓塞术（utreine artery embolization ，UAE）、高强度聚焦超声（high intensity focused ultrasound ，HIFU ）三种方式治疗宫肌瘤的临床疗效。方法：回顾性分析2009年1月-2011年1月在我院行腹腔镜下行子宫肌瘤剔除术患者60例、子宫动脉栓塞术患者11例、高强度聚焦超声治疗术患者47例的临床资料。术后随访12月，评价临床疗效。结果：LM组手术时间、术中出血量均高于UAE组及HIFU组，HIFU组术后住院天数明显少于LM组及UAE组，差异有统计学意义；有效率：术后随访12月，LA组肌瘤术后瘤体全部消失，45例临床症状明显改善，15例症状部分改善，总有效率达100％；UAE组1例术后瘤体无明显缩小，总有效率为91％；HIFU组3例瘤体缩小不明显，1例临床症状加重，改行其他方式治疗，总有效率为92％。3组间总有效率比较差异无显著性意义（P＞0．05），治愈率比较有统计学意义（P＜0．05），以LM组最高。全部病例均无严重并发症及重要脏器损伤。结论：三种方式均能有效的治疗子宫肌瘤。LM组术后临床症状迅速改善，但此术式需要良好的手术技巧；UAE及HIFU两种方式创伤更小，但肌瘤缩小及症状缓解需较长时间。三种方式各有其特点及适应症，选择治疗方式前应综合评估。
목적：비교복강경하자궁기류척제술（laparoscopic myomectomy ，LM）、자궁동맥전새술（utreine artery embolization ，UAE）、고강도취초초성（high intensity focused ultrasound ，HIFU ）삼충방식치료궁기류적림상료효。방법：회고성분석2009년1월-2011년1월재아원행복강경하행자궁기류척제술환자60례、자궁동맥전새술환자11례、고강도취초초성치료술환자47례적림상자료。술후수방12월，평개림상료효。결과：LM조수술시간、술중출혈량균고우UAE조급HIFU조，HIFU조술후주원천수명현소우LM조급UAE조，차이유통계학의의；유효솔：술후수방12월，LA조기류술후류체전부소실，45례림상증상명현개선，15례증상부분개선，총유효솔체100％；UAE조1례술후류체무명현축소，총유효솔위91％；HIFU조3례류체축소불명현，1례림상증상가중，개행기타방식치료，총유효솔위92％。3조간총유효솔비교차이무현저성의의（P＞0．05），치유솔비교유통계학의의（P＜0．05），이LM조최고。전부병례균무엄중병발증급중요장기손상。결론：삼충방식균능유효적치료자궁기류。LM조술후림상증상신속개선，단차술식수요량호적수술기교；UAE급HIFU량충방식창상경소，단기류축소급증상완해수교장시간。삼충방식각유기특점급괄응증，선택치료방식전응종합평고。
Objective :To disscuss the characteristics of treatments for hysteromyoma ,the efficacy of laparoscopic myomectomy (LM ) , utreine artery embolization (UAE) and high intensity focused ultrasound (HIFU) were observed in this study .Method :Retrospective analyzing 118 hysteromyoma cases ,who came into our hospital and demanded their uterine retained between 2009 .1 and 2011 .1 ;6o cases in the LM group ,11 cases in the UAE group ,47 cases in the HIFU group ,respetively ;observing the condition of the three groups during the perioperative period ;comparing the surgical results and the post - operation recovery ;follow -up twelve months after operation before evaluating the curative effect .Results :the time and the amount of bleeding within the operation ,LM group is higher than both of the UAE and HIFU group .the differences between the three groups are significant (P<0 .05);effetive rate :the neoplasma disappears totally in the LA group after operation -45 cases’ clinical symptoms have got obvious improvement ;15 cases’ symptoms have got partial improvement ,the whole possibility of effectiveness amounts to a hundred percent ;2 cases’ myoma didnot shrink after operation in the UAE group ,and the effective rate is 81 percent ;Three cases’ myoma didnot reduce conspicuously ,clinical symptoms have not got obvious improvement ,then other surgical methods were added ,effective rate is 92 percent.The whole possibility of effectiveness of three groups are no significant difference .There were significant difference in the cure rate (P< 0 .05) ,and the cure rate of LM group is the most .The reducing volume of hysteromyoma and resission in UAE group and LM group need more time .there are not any severe complications and vital organs injury in the three groups .Conclusion :Three kinds of treatment is effective in the treatment of urerine fibroids .LM group of postoperative clinical symptoms quickly improved ,but the operatinon need good surgical skills ;UAE and HIFU two ways have less wounds ,but reducing symptoms needs a long time .Three ways each has its characteristics and indications ,choose before treatment should be comprehensive evaluation .