摘要
目的探讨在特殊情况下施行阴式辅助腹腔镜子宫肌瘤剔除术(transvaginal-assisted laparoscopic myomectomy,VALM)的可行性、安全性。方法 2006年3月～2010年5月,行腹腔镜子宫肌瘤剔除术148例,其中24例行阴式辅助腹腔镜子宫肌瘤剔除术,包括较大子宫肌壁间(6～8 cm)近黏膜下肌瘤8例、子宫下段肌瘤3例、子宫腺肌瘤术前彩超误诊为子宫肌瘤4例、对于子宫肌瘤粉碎后取出有顾虑强烈要求完整取出肌瘤者5例、子宫肌瘤囊性变4例。结果所有病例均经阴式辅助顺利完成手术。2例术中触诊发现术前超声未提示肌壁间直径约1 cm肌瘤结节3枚,行剔除术。无中转开腹、临近脏器损伤。术中出血量50～120 ml,(75.4±22.1)ml,手术时间40～90 min,(63.5±14.7)min。无术后发热、感染等并发症。术后专人定期电话随访2～51个月,(38.1±12.9)月,均无复发。结论 VALM安全可行,可以拓展腹腔镜及阴式子宫肌瘤剔除术的适应证,并作为困难腹腔镜手术的一种补救措施,避免中转开腹。
ObjectiveTo analyze the feasibility and safety of transvaginal-assisted laparoscopic myomectomy（VALM） in exceptional cases of hysteromyoma.MethodsFrom March 2006 to May 2010,we performed laparoscopic myomectomy on 148 patients,including 24 cases of VALM.In the 24 cases,8 patients had large intramural myoma（6-8 cm in diameter）;3 patients showed myoma in the lower uterus;4 patients were misdiagnosed with myoma by color Doppler before the operation,and then was confirmed as having adenomyoma during the surgery;5 patients refused to receive myoma fragmentation,and requested an en bloc removal;the other 4 patients showed cystic degeneration of the uterus.ResultsThe procedure was completed in all the patients without conversion to open surgery or causing to organ injuries.During the surgery,in two cases,we detected three more intramural myoma with a diameter of 1 cm,which were not found out by pre-operative B-ultrasonography.The mean operation in this series was（63.5±14.7） minutes（ranged from 40 to 90 minutes）,and the intraoperative blood loss was（75.4±22.1） ml（50-120）.No patient had fever or infection after the operation.We followed up the patients by phone call for 2-51 months with a mean of（38.1±12.9） months.During the period,no patient had recurrence.ConclusionVALM is safe and feasible for hysteromyoma with exceptional conditions.We suggest to widen the indications for VALM,and make the procedure as an supplement for difficult laparoscopic myomectomy so that to avoid conversion to open surgery.
出处
《中国微创外科杂志》
CSCD
2011年第4期344-346,共3页
Chinese Journal of Minimally Invasive Surgery
