CAJ | 학술논문

目的：探讨对要求保留子宫的宫颈肌瘤患者进行经阴道剔除术与经腹腔镜剔除术的临床疗效。方法采集2012年1月至2014年1月在首都医科大学附属北京妇产医院妇科微创中心住院治疗的72例单发宫颈肌瘤患者为研究对象,平均年龄为(35.1±4.6)岁。采用数字表随机法将其分为经阴道组(n=36)与经腹腔镜组(n=36),两组患者平均年龄分别为(35.6±4.5)岁与(34.2±4.8)岁；宫颈肌瘤最大直径分别为(5.2±2.4)cm 与(4.9±2.6)cm；对其分别采取经阴道宫颈肌瘤剔除术与经腹腔镜宫颈肌瘤剔除术。统计学分析两组患者手术时间、术中出血量及术后最高体温、肛门排气时间、抗菌药物使用天数及住院天数等。本研究遵循的程序符合首都医科大学附属北京妇产医院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象本人的知情同意,并与之签署临床研究知情同意书。两组患者的平均年龄及肌瘤最大直径比较,差异无统计学意义(t=1.5529,0.5087；P >0.05)。结果两组患者手术过程均顺利,无一例中转开腹,均无邻近器官损伤及术后并发症发生。经腹腔镜组与经阴道组患者手术时间分别为(99.5±45.5)min 与(78.4±25.3)min,术中出血量分别为(150.1±88.5)mL 与(116.4±40.5)mL,两组比较,差异均有统计学意义(t=2.4318,2.0775；P <0.05)。经腹腔镜组与经阴道组患者的术后最高体温比较,差异无统计学意义(t =0.7682,P >0.05)；两组术后肛门排气时间分别为(15.3±5.3)h 与(12.9±4.2)h,抗菌药物使用天数分别为(3.4±2.5)d 与(2.2±1.2)d,住院天数分别为(5.2±1.8)d 与(4.4±1.2)d,两组比较,差异均有统计学意义(t =2.1294,2.5964,2.2188；P <0.05)。结论经阴道剔除术与经腹腔镜剔除术对治疗宫颈肌瘤均安全可行。二者均具有创伤小、术后恢复快等优点,但经阴道宫颈肌瘤剔除术较经腹腔镜剔除术的手术时间更短、术中出血量更少,而且术后肛门排气时间更短、抗菌药物使用天数和住院天数亦更短,故更具微创意义。目的：探討對要求保留子宮的宮頸肌瘤患者進行經陰道剔除術與經腹腔鏡剔除術的臨床療效。方法採集2012年1月至2014年1月在首都醫科大學附屬北京婦產醫院婦科微創中心住院治療的72例單髮宮頸肌瘤患者為研究對象,平均年齡為(35.1±4.6)歲。採用數字錶隨機法將其分為經陰道組(n=36)與經腹腔鏡組(n=36),兩組患者平均年齡分彆為(35.6±4.5)歲與(34.2±4.8)歲；宮頸肌瘤最大直徑分彆為(5.2±2.4)cm 與(4.9±2.6)cm；對其分彆採取經陰道宮頸肌瘤剔除術與經腹腔鏡宮頸肌瘤剔除術。統計學分析兩組患者手術時間、術中齣血量及術後最高體溫、肛門排氣時間、抗菌藥物使用天數及住院天數等。本研究遵循的程序符閤首都醫科大學附屬北京婦產醫院人體試驗委員會所製定的倫理學標準,得到該委員會批準,分組徵得受試對象本人的知情同意,併與之籤署臨床研究知情同意書。兩組患者的平均年齡及肌瘤最大直徑比較,差異無統計學意義(t=1.5529,0.5087；P >0.05)。結果兩組患者手術過程均順利,無一例中轉開腹,均無鄰近器官損傷及術後併髮癥髮生。經腹腔鏡組與經陰道組患者手術時間分彆為(99.5±45.5)min 與(78.4±25.3)min,術中齣血量分彆為(150.1±88.5)mL 與(116.4±40.5)mL,兩組比較,差異均有統計學意義(t=2.4318,2.0775；P <0.05)。經腹腔鏡組與經陰道組患者的術後最高體溫比較,差異無統計學意義(t =0.7682,P >0.05)；兩組術後肛門排氣時間分彆為(15.3±5.3)h 與(12.9±4.2)h,抗菌藥物使用天數分彆為(3.4±2.5)d 與(2.2±1.2)d,住院天數分彆為(5.2±1.8)d 與(4.4±1.2)d,兩組比較,差異均有統計學意義(t =2.1294,2.5964,2.2188；P <0.05)。結論經陰道剔除術與經腹腔鏡剔除術對治療宮頸肌瘤均安全可行。二者均具有創傷小、術後恢複快等優點,但經陰道宮頸肌瘤剔除術較經腹腔鏡剔除術的手術時間更短、術中齣血量更少,而且術後肛門排氣時間更短、抗菌藥物使用天數和住院天數亦更短,故更具微創意義。
목적：탐토대요구보류자궁적궁경기류환자진행경음도척제술여경복강경척제술적림상료효。방법채집2012년1월지2014년1월재수도의과대학부속북경부산의원부과미창중심주원치료적72례단발궁경기류환자위연구대상,평균년령위(35.1±4.6)세。채용수자표수궤법장기분위경음도조(n=36)여경복강경조(n=36),량조환자평균년령분별위(35.6±4.5)세여(34.2±4.8)세；궁경기류최대직경분별위(5.2±2.4)cm 여(4.9±2.6)cm；대기분별채취경음도궁경기류척제술여경복강경궁경기류척제술。통계학분석량조환자수술시간、술중출혈량급술후최고체온、항문배기시간、항균약물사용천수급주원천수등。본연구준순적정서부합수도의과대학부속북경부산의원인체시험위원회소제정적윤리학표준,득도해위원회비준,분조정득수시대상본인적지정동의,병여지첨서림상연구지정동의서。량조환자적평균년령급기류최대직경비교,차이무통계학의의(t=1.5529,0.5087；P >0.05)。결과량조환자수술과정균순리,무일례중전개복,균무린근기관손상급술후병발증발생。경복강경조여경음도조환자수술시간분별위(99.5±45.5)min 여(78.4±25.3)min,술중출혈량분별위(150.1±88.5)mL 여(116.4±40.5)mL,량조비교,차이균유통계학의의(t=2.4318,2.0775；P <0.05)。경복강경조여경음도조환자적술후최고체온비교,차이무통계학의의(t =0.7682,P >0.05)；량조술후항문배기시간분별위(15.3±5.3)h 여(12.9±4.2)h,항균약물사용천수분별위(3.4±2.5)d 여(2.2±1.2)d,주원천수분별위(5.2±1.8)d 여(4.4±1.2)d,량조비교,차이균유통계학의의(t =2.1294,2.5964,2.2188；P <0.05)。결론경음도척제술여경복강경척제술대치료궁경기류균안전가행。이자균구유창상소、술후회복쾌등우점,단경음도궁경기류척제술교경복강경척제술적수술시간경단、술중출혈량경소,이차술후항문배기시간경단、항균약물사용천수화주원천수역경단,고경구미창의의。
Objective To explore the therapeutic effects of transvaginal cervical myomectomy and laparoscopic cervical myomectomy on patients who required to retain uterus.Methods A total of 72 inpatients in Center of Minimally Invasive Gynecology,Beijing Obstetrics and Gynecology Hospital from January 2012 to January 2014 with single cervical myoma were enrolled in this study.Their average age was (35.1±4.6)years old.The participants were randomly divided into two groups by digital table method, transvaginal cervical myomectomy group (n = 36 )whose average age were (35.6 ± 4.5 )years old ,and laparoscopic cervical myomectomy group (n = 36 )whose average age were (34.2 ± 4.8 )years old.The maximum diameters of cervical myoma in transvaginal cervical myomectomy group and laparoscopic cervical myomectomy group were (5.2 ± 2.4)cm and (4.9 ± 2.6 )cm,respectively.The indices of observation, such as duration of operation,blood loss volume,maximum body temperature after operation,time of anal exhaust after operation,time of antibiotics use and hospitalization time were analyzed by statisticsal method. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Beijing Obstetrics and Gynecology Hospital.Informed consent was obtained from all participants.There were no significance differences between two groups on average age and maximum diameter of cervical myoma (t =1.552 9,0.508 7;P >0.05 ).Results The operations were completed successfully in both two groups, without conversion to laparotomy,injury of adjacent organs or postoperative complications.The durations of operation in laparoscopic cervical myomectomy group and transvaginal cervical myomectomy group were (99.5±45.5)min and (78.4±25.3)min,respectively,blood loss volumes were (1 50.1 ±88.5)mL and (1 1 6.4±40.5)mL,respectively,and both showed significant difference (t=2.431 8,2.077 5;P <0.05). The maximum body temperatures after operation in laparoscopic cervical myomectomy group and transvaginal cervical myomectomy group showed no significant difference (t=0.768 2,P >0.05).The time of anal exhaust after operation in laparoscopic cervical myomectomy group and transvaginal cervical myomectomy group were (1 5.3 ± 5.3 )h and (12.9 ± 4.2 )h,respectively,durations of antibiotics treatment were (3.4±2.5)d and (2.2±1.2)d,respectively,hospitalization time were (5.2 ±1.8)d and (4.4±1.2)d,respectively,and all showed significant differences (t = 2.129 4,2.596 4,2.218 8;P <0.05).Conclusions Transvaginal cervical myomectomy and laparoscopic cervical myomectomy are both safe and practicable.Patients after operation above have minor wound and rapid recovery from operation. Compared with laparoscopic cervical myomectomy,transvaginal cervical myomectomy have shorter operation time,less blood loss volumes,shorter time of anal exhaust after operation,shorter time of antibiotics treatment and less days of hospitalization,and thus more minimally invasive and worthy of promotion.