目的 探讨腹腔镜下复杂性子宫肌瘤剥除的可行性、安全性及手术技巧.方法 回顾性分析江阴市人民医院妇科2014年6月至2016年6月采用腹腔镜或开腹进行的复杂性子宫肌瘤剥除手术300例,其中腹腔镜组150例,设为观察组,开腹组150例,设为对照组,比较两组的手术治疗效果.结果 与对照组相比,观察组手术时间明显增加,比较差异具有统计学意义(t=12.42,P=0.00),而两组术中出血量、副损伤发生率比较,无明显统计学意义(t=-1.71,P=0.09;x2=1.10,P=0.31);观察组术后肛门排气时间、住院时间明显缩短,术后镇痛用药率低,两组差异比较均有统计学意义(t=-14.18,P=0.00;t=-21.61,P=0.00;x2=66.52,P=0.00);观察组切口愈合不良率、术后病率、术后肠粘连、肠梗阻发生率均显著降低,患者满意度较高,差异比较具有统计学意义(x2值分别为7.49、7.28、5.56、21.60,均P＜0.05);观察组术后残瘤率、复发率稍高于对照组,但两者差异比较无明显统计学意义(x2值分别为2.54、0.22,均P＞0.05);两组妊娠率比较无明显统计学意义(x2 =0.44,P=0.51),且两组无1例妊娠期发生子宫破裂.结论 与开腹手术相比,腹腔镜下行复杂性子宫肌瘤剥除虽然手术时间长,但术后恢复快,并发症少,患者满意度高,具有较好的临床推广应用.%Objective To discuss the feasibility,safety and surgical skills of laparoscopic complex myomectomy.Methods A retrospective analysis on 300 cases of laparoscopic or transabdominal complex myomectomy was carried out from June 2014 to June 2016 in Jiangyin Peoples' Hospital.Of them 150 cases experiencing laparoscopic myomectomy were treated as observation group and the rest were set as control group.Surgical treatment effect was compared between two groups.Results Compared to the control group,the operation time of the observation group increased significantly (t =12.42,P =0.00).The intraoperative blood loss and incidence of secondary injury of two,groups were not statistically different (t =-1.71 P =0.09;x2=1.10,P =0.31).Postoperative anal exhaust time and hospital stay of the observation group were significantly shorten with lower postoperative analgesia rate (t =-14.18,P =0.00;t =-21.61,P =0.00;x2 =66.52,P =0.00).The incidences of poor healing,postoperative morbidity,postoperative intestinal adhesion and intestinal obstruction were significantly lower in the observation group,and the patients' satisfaction was higher with significant difference (x2 value was 7.49,7.28,5.56 and 21.60,respectively,all P ＜ 0.05).The postoperative residual tumor rate and recurernce rate in the observation group were slightly higher than the control group,but the differences were not statistically significant (x2 value was 2.54 and 0.22,resepctively,both P ＞ 0.05).Pregnancy rate of two groups was not statistically different (x2 =0.44,P =0.51),and no pregnancy uterine rupture was found in two groups.Conclusion Although the operation time is longer,laparoscopic surgery has the advantages of faster recovery,less complications and higher satisfaction,and it has better application in clinical practice compared to transabdominal surgery.
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