腹腔镜辅助阴式全子宫切除术对巨大子宫肌瘤的疗效

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　　 【摘要】 目的：观察巨大子宫肌瘤患者行腹腔镜辅助阴式全子宫切除术治疗的价值。方法：选取2017年2月-2019年4月于笔者所在医院妇产科接受治疗的88例巨大子宫肌瘤患者为研究对象，以随机数字表法均分为两组，对照组接受开腹全子宫切除术，观察组接受腹腔镜辅助阴式全子宫切除术，比较两组手术指标、并发症发生率及炎症反应指标。结果：观察组手术时间、术后排气时间、术中出血量、术后下床活动时间及住院时间均优于对照组（P<0.01）;观察组并发症发生率为4.5%，明显低于对照组的22.7%（P<0.05）;两组术后CRP、IL-6、IL-2水平均较术前显著升高，且观察组术后CRP、IL-6、IL-2水平均低于对照组（P<0.05）。结论：巨大子宫肌瘤患者接受腹腔镜辅助阴式全子宫切除术治疗，具有创伤小、恢复快、并发症发生率低，安全性高的优势，建议在严格掌握手术适应证的前提下优先考虑。
　　 【关键词】 巨大子宫肌瘤 腹腔镜 阴式全子宫切除术 开腹术
　　 doi：10.14033/j.cnki.cfmr.2020.01.060 文献标识码 B 文章编号 1674-6805（2020）01-0-03
　　 [Abstract] Objective： To observe the value of laparoscopic-assisted vaginal hysterectomy for patients with giant uterine leiomyoma. Method： A total of 88 patients with giant uterine leiomyoma admitted to the department of obstetrics and gynecology of our hospital from February 2017 to April 2019 were selected as the study objects. According to the random number table， patients were divided into two groups. The control group was treated with transabdominal hysterectomy and the observation group was treated with laparoscopic-assisted vaginal hysterectomy. The indexes of operation， incidence of complications and indexes of inflammatory response were compared between the two groups. Result： The operation time， postoperative exhaust time， intraoperative bleeding volume， postoperative get out of bed time and hospital stay in the observation group were better than those of the control group （P<0.01）. The incidence of complications was 4.5% in the observation group， which was lower than 22.7% of the control group （P<0.05）. After operation， the levels of CRP， IL-6 and IL-2 in the two groups were significantly higher than those before operation， and the levels of CRP， IL-6 and IL-2 in the observation group were lower than those of the control group （P<0.05）. Conclusion： Laparoscopic-assisted vaginal hysterectomy for patients with giant uterine leiomyoma has the advantages of minimal trauma， rapid recovery， low incidence of complications and high safety. It is suggested that priority should be given to the patients under the premise of strict control of operative indications.
　　 [Key words] Giant uterine leiomyoma Laparoscope Vaginal hysterectomy Laparotomy
　　 First-author’s address： Maternal and Child Health Hospital of Xiaogan， Xiaogan 432000， China
　　 子宮肌瘤是妇科疾病中发病率较高的疾病，巨大子宫肌瘤指子宫体积>12孕周或子宫肌瘤直径≥8 cm[1]。以往临床上治疗巨大子宫肌瘤多采取经腹子宫肌瘤全切术（开腹手术），虽然临床效果确切，但手术创伤较大、并发症多，且术后瘢痕明显，整体效果不甚满意[2]。随着微创理念的不断深入和腹腔镜技术的发展，腹腔镜辅助阴式全子宫切除术对子宫肌瘤大小的要求不断放宽，由于具有创伤小、术后恢复快、术后体表无瘢痕、安全性高等优势越来越受人们青睐[3]。近年，研究者开始尝试将腹腔镜技术应用于巨大子宫肌瘤治疗中[4]。为探讨腹腔镜技术在巨大子宫肌瘤治疗中的效果，本研究对巨大子宫肌瘤患者行腹腔镜辅助阴式全子宫切除术治疗情况进行观察分析。
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