子宮動脈阻斷對腹腔鏡下行子宮肌瘤剔除術(shù)的臨床意義探討

張梅 蔣瓊

【摘要】目的：探討腹腔鏡下子宮動脈阻斷后行子宮肌瘤剔除術(shù)對子宮肌瘤患者的臨床應用價值及其影響。方法：回顧分析2011年1月至2013年1月我院收治的288例子宮肌瘤患者的臨床資料，根據(jù)手術(shù)方式分為觀察組和對照組，其中觀察組在腹腔鏡下子宮動脈阻斷后行子宮肌瘤剔除術(shù)，對照組僅行腹腔鏡下子宮肌瘤剔除術(shù)。對比兩組在術(shù)前肌瘤最大徑≤9cm、>9cm以及總體分析時術(shù)中情況、術(shù)后卵巢功能恢復、預后、妊娠等方面的差異。結(jié)果：觀察組手術(shù)時間、術(shù)中出血量及住院時間均少于對照組，而術(shù)前肌瘤最大徑≤9cm患者手術(shù)中，對照組手術(shù)時間少于觀察組（P<0.05）；觀察組FSH、LH及E2均低于對照組（P<0.05）；與對照組相比，觀察組月經(jīng)異常癥狀緩解明顯、肌瘤復發(fā)率降低、發(fā)生閉經(jīng)較少及子宮體積縮小明顯（P<0.05），而術(shù)前肌瘤最大徑≤9cm患者手術(shù)中，兩組術(shù)后2個月月經(jīng)異常癥狀緩解無統(tǒng)計學差異（P>0.05）；隨訪2年，兩組妊娠情況比較無統(tǒng)計學差異（P>0.05）。結(jié)論：腹腔鏡下子宮動脈阻斷后行子宮肌瘤剔除術(shù)能有效減少術(shù)中出血、減小手術(shù)創(chuàng)傷、降低子宮肌瘤復發(fā)率，對內(nèi)分泌及妊娠無明顯影響，值得臨床推廣。

【關(guān)鍵詞】子宮肌瘤；腹腔鏡；子宮動脈栓塞術(shù)；子宮肌瘤剝除術(shù)

Clinical study on the role of laparoscopic hysteromyomectomy for uterine artery blockageZHANG Mei， JIANG Qiong△. Department of Obstetrics and Gynecology， Shiyan Traditional Chinese Medicine Hospital， Shiyan 442000， Hubei， China

【Abstract】Objectives： To investigate the effect of laparoscopic hysteromyomectomy for uterine artery blockage. Methods： The clinical data of 288 cases of hysteromyoma from 2011 to 2013 were analyzed retrospectively. They were divided into experimental group （laparoscopic hysteromyomectomy with uterine artery blockage） and control group （laparoscopic hysteromyomectomy without uterine artery blockage）. The condition during operation， postoperative recovery of ovarian function， prognosis， and the probability of pregnancy of two groups were compared. Results： Comparing with the control group， the operation time， blood loss and hospital stay length of experimental group were reduced， but the operation time extended in the maximum diameter ≤9cm uterine fibroids surgery （P<0.05）. FSH， LH and E2 of experimental group were lower than the control group （P<0.05）. Menstrual abnormalities of experimental group were relieved； fibroid recurrence rate was reduced； amenorrhea was more and uterine volume was reduced （P<0.05）， while the difference in menstrual abnormalities was not significant in the maximum diameter ≤9cm uterine fibroids surgery （P>0.05）. Pregnancy between the two groups was of no significant difference by 2-year follow-up （P>0.05）. Conclusion： Laparoscopic hysteromyomectomy for uterine artery blockage is effective in decreasing intraoperative blood loss， operative trauma and recurrence rate without significant effect on endocrine and pregnancy， which deserves clinical expansion.

【Key words】Uterine fibroids； Laparoscopic surgery； Uterine artery embolization； Hysteromyomectomy

【中圖分類號】R711.74【文獻標志碼】A

子宮肌瘤是婦科最常見的良性腫瘤，臨床可表現(xiàn)為月經(jīng)量過多、繼發(fā)失血性貧血、盆腔腫物壓迫等，對患者的身心健康和生活質(zhì)量影響較大[1]。目前，腹腔鏡微創(chuàng)手術(shù)因其手術(shù)療效肯定、術(shù)后并發(fā)癥少、術(shù)后恢復快、切口美觀等優(yōu)點，已經(jīng)在子宮肌瘤臨床治療時廣泛應用。但是，該術(shù)式亦存在大肌瘤、多發(fā)肌瘤剔除手術(shù)術(shù)中止血難、術(shù)后出血多等弊端[2]，有時甚至需要中轉(zhuǎn)開腹從而延長了手術(shù)時間、加劇了手術(shù)應激創(chuàng)傷，往往術(shù)后復發(fā)率較高。本研究……