【摘要】 目的:探讨腹腔镜多发性子宫肌瘤切除术术中止血及残存肌瘤的处理方法。方法:66例患者中30例行开腹子宫肌瘤切除术,36例行腹腔镜手术。肌瘤最多12个,最少2个。腹腔镜组中18例行单纯腹腔镜子宫肌瘤切除术,18例行腹腔镜子宫肌瘤切除术加子宫动脉阻断术。腹腔镜子宫肌瘤切除术中结合B超监测。结果:开腹手术后平均住院(7.21±0.85)d,术后排气时间(31.15±7.26)h,腹腔镜术后平均住院(4.72±0.81)d,术后排气时间(21.13±5.36)h。单纯腹腔镜手术:平均手术时间(98±24)min,术中出血(129.7±58.6)ml,术后复发率26.3%。腹腔镜联合子宫动脉阻断术:平均手术时间(105.6±27.6)min,术中平均出血(87.52±18.35)ml,术后复发3.1%。结论:患者行腹腔镜多发性子宫肌瘤切除术后康复快。由于腹腔镜手术的进展,选择病例的范围更广泛,联合子宫动脉阻断术比单纯腹腔镜手术电切、分离、缝扎等安全可靠,且出血少,复发率低,术中B超监测降低了肌瘤切除术的漏切率。更多还原

【Abstract】 Objective:To investigate the methods of hemostasis and management of residual hysteromyoma in laparoscopic multiple myomectomy.Methods:Sixty-six patients underwent open (n=30) or laparoscopic myomectomy (n=36) respectively.The number of hysteromyoma was 2-12.18 cases in laparoscopic group underwent simple myomectomy,the other 18 cases received laparoscopic myomectomy and uterine artery occlusion.B-ultrasonography was used to monitor laparoscopic myomectomy.Results:Postoperative hospital stay was (7.21±0.85)d in open group and (4.72±0.81)d in laparoscopic group respectively.The postoperative exhaust time was (31.15±7.26)h in open group and (21.13±5.36)h in laparoscopic group.In the simple laparoscopic surgery,the operative time was (98±24)min,intraoperative blood loss was (129.7±58.6)ml,postoperative recurrence rate was 26.3%,these data in laparoscopic uterine artery occlusion group were (105.6±27.6)min,(87.52±18.35)ml,and 3.1% respectively.Conclusions:Patients who underwent laparoscopic multiple myomectomy recover rapidly.The operative indication increases as the progress of laparoscopic surgery.Compared with electro-resection,separation and suture in simple laparoscopic operation,uterine artery occlusion is safer,more reliable,of less blood loss and lower recurrence rate.Intraoperative B-ultrasonography monitoring decreases the omission rate of myomectomy.更多还原