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目的:观察改良腹腔镜下巨大子宫壁间肌瘤剔除术的临床效果及安全性。方法:选择要求保留子宫的巨大子宫壁间肌瘤64例,随机分为观察组和对照组各32例。观察组行改良腹腔镜下子宫肌瘤剔除术,术中边旋切边剔除瘤核,待取出瘤核后,再缝合子宫切口;对照组行常规腹腔镜下子宫肌瘤剔除术,术中先剔除瘤核,待缝合子宫切口后,再旋切瘤核并取出。比较两组手术时间、术中出血量、瘤核总重量,以及术后肛门排气时间、术后发热情况等。结果:所有患者均在腹腔镜下完成手术,无一例中转开腹,术中及术后均未出现严重并发症。观察组手术时间和术中出血量,显著短于或少于对照组(P<0.05);术后肛门排气时间和瘤核总重量与对照组比较,差异不显著(P>0.05)。除对照组1例给予输血治疗外,其余患者均未行输血治疗。观察组术后发热6例,占18.8%;对照组为10例,占31.2%;两组比较,差异显著(P<0.05)。随访1年,两组均未发现肌瘤复发。结论:改良腹腔镜下巨大子宫壁间肌瘤剔除术可行且较安全。
Objective: To observe the clinical effect and safety of modified laparoscopic giant uterine myomectomy. Methods: Sixty-four cases of giant uterine fibroids requiring uterine preservation were selected and randomly divided into observation group and control group with 32 cases each. The observation group underwent modified laparoscopic myomectomy. During the operation, the tumor nuclei were excised by spin-cutting while the tumor nuclei were to be removed, and then the uterine incision was sutured. The control group underwent routine laparoscopic myomectomy, Remove the tumor nucleus, to be sutured uterine incision, and then remove the tumor nuclei and removed. The operation time, intraoperative blood loss, total tumor weight, as well as postoperative anal exhaust time and postoperative fever were compared between the two groups. Results: All the patients underwent laparoscopic surgery. No one was converted to laparotomy. No serious complications occurred during and after operation. The operation time and intraoperative blood loss in observation group were significantly shorter than those in control group (P <0.05). There was no significant difference in anal exhaust time and total tumor weight between control group and control group (P> 0.05). In addition to the control group of 1 patients given blood transfusions, the remaining patients were not transfused. Postoperative fever in observation group 6 cases, accounting for 18.8%; control group was 10 cases, accounting for 31.2%; two groups, the difference was significant (P <0.05). One year follow-up, no recurrence of myoma was found in either group. Conclusion: The modified laparoscopic myomectomy is feasible and safe.