2/3外凸肌瘤基底部套扎法腹腔镜肌瘤剔除术的临床价值

Clinical value of base loop ligation of 2/3 convex myomas by laparoscopic myomectomy

摘要:

目的??探讨腹腔镜下子宫肌瘤基底部套扎免缝合法剔除2/3外凸子宫肌瘤的临床疗效。方法?选择2013年1月－2015年11月在该院住院的56例需要腹腔镜手术治疗2/3外凸子宫肌瘤的患者。26例进行腹腔镜下肌瘤基底部套扎免缝合法剔除子宫肌瘤（免缝合组），30例进行常规的腹腔镜下缝合法剔除子宫肌瘤（缝合组），比较分析两组的手术时间、术中出血量、排气时间、术后3天腹腔引流总量及术后第1、2、3及6个月盆腔彩超。结果?56例均成功地完成了腹腔镜下手术，免缝合组平均手术时间（76.96±21.11）min，平均术中出血量（17.69±12.90）ml，平均术后3天腹腔引流总量（84.81±35.28）ml，以上数据均明显少于缝合组，差异有统计学意义（P <0.01），两组术后排气时间比较，差异无统计学意义（P >0.05），术后彩超提示缝合组均无肌瘤残腔形成，免缝合组肌瘤残留基底座逐渐被吸收，第3个月57.69%（15/26）的患者肌瘤底座完全吸收，平均吸收率（91.58±14.82）%，至第6个月所有患者均完全吸收，肌壁回声均匀连续。结论?腹腔镜下肌瘤基底部套扎免缝合法子宫肌瘤剔除术可有效地缩短手术时间，减少术中出血，降低术后出血和渗出，减小术后创面，保留子宫肌层的完整，是一种安全简单又效果显著的手术方法。

Abstract:

Objective?To evaluate the clinical value of base loop ligation of 2/3 convex myomas without sutruing by laparoscopic myomectmy (LM). ?Methods?56 women in needs of LM treatment from January 2013 to November 2015 were divided into Free-sutrue Group: 26 cases, with base loop ligation of the myomas without sutruing by LM and Sutrue Group: 30 cases, with convertional sutrue by LM. Then the operating time, operative blood loss, postoperative exhaust time, postoperative total peritoneal drainage within 3 days and ultrasound of 1 month, 2 months, 3 months and 6 months after surgery of the two groups were compared.?Results?All the operations were successfully performed. In Free-sutrue Group, the mean operating time and the mean operative blood loss were (76.96 ± 21.11) min and (17.69 ± 12.90) ml, and the mean postoperative total peritoneal drainage within 3 days were (84.81 ± 35.28) ml, they were all significantly less than the Suture Group (P < 0.01), postoperative gastrointestinal recovery time between two groups were not statistically significantly. Ultrasound prompted Suture Group had no residual cavity formed. In Free-sutrue Group, ultrasound showed that the base were absorded gradually. The first three months of 57.69 % (15/26) of patients with fibroids base completely absorbed, the average absorption rate (91.58 ± 14.82) %, to 6 months, all patients were completely absorbed.?Conclusion?The method of base loop ligation of the 2/3 convex myomas without sutruing by laparoscopic myomectmy has shorter operating time and less blood loss, reduce postoperative bleeding and oozing, retention myometrium complete, it is a safe and simple and significant effect of surgical method.