摘要
目的探讨腹腔镜子宫肌瘤剔除术(LM)与开腹子宫肌瘤剔除术(AM)术中、术后情况,及其对围术期应激反应及妊娠结局的影响。方法选取自2012年11月至2015年3月行子宫肌瘤剔除术的211例患者,根据手术方法分为AM组(n=97)与LM组(n=114)。观察并比较两组患者术中情况、术后情况、术后妊娠结局、术后妊娠情况及术前术后肾上腺素(E)、去甲肾上腺素(NE)水平。结果两组患者术中情况比较,LM组术中失血量为(82.03±50.13)ml,明显少于AM组的(131.19±64.44)ml;手术时间为(97.68±33.27)min,长于AM组的(82.99±17.62)min,两组间比较,差异均有统计学意义(P<0.05)。两组患者术后临床情况比较,LM组发热患者占10.5%(12/114),明显低于AM组的39.2%(38/97);24 h肛门排气患者占83.3%(95/114),明显高于AM组的52.6%(51/97);使用镇痛剂占18.4%(21/114),明显低于AM组的34.0%(33/97);术后住院时间为(4.05±1.79)d,明显短于AM组的(7.47±2.22)d,两组间比较,差异均有统计学意义(P<0.05)。术后妊娠结局比较,LM组9.5%(4/42)患者因手术影响行人工流产,AM组20.6%(7/34)患者因手术影响行人工流产,两组间比较,差异有统计学意义(P<0.05)。术后妊娠情况比较,LM组妊娠患者16.7%(6/36)采取阴道分娩,83.3%(30/36)采取剖宫产;AM组妊娠患者8.0%(2/25)采取阴道分娩,92.0%(23/25)采取剖宫产,两组间比较,差异均有统计学意义(P<0.05)。术前两组患者血清中E和NE水平比较,差异无统计学意义(P>0.05);术后两组患者血清中E和NE水平均较治疗前升高,且LM组明显低于AM组,差异有统计学意义(P<0.05)。结论 LM与AM均是安全有效治疗子宫肌瘤的手段,LM具有创伤小、术中出血量少、患者术后恢复快、依从性好、对妊娠结局和机体应激反应影响小等优势。
Objective To investigate the effect of laparoscopic and abdominal myomectomy for uterine fibroids surgery on postoperative stressstate and recurrence of fibroids and pregnancy outcome. Methods A retrospective study was performed on 211 cases of patients undergoing myomectomy from November 2012 to March 2015. According to surgery methods,patients were divided into the AM group（ n = 97） and LM group（ n = 114）. The intraoperative conditions,postoperative conditions,postoperative pregnancy outcome,postoperative pregnancy and postoperative epinephrine（ E） and norepinephrine（ NE） levels in the two groups were observed and compared. Results In the two groups of patients,the blood loss in the LM group was（ 82. 03 ± 50. 13） ml,significantly less than（ 131. 19 ± 64. 44） ml of the AM group; the operation time was（ 97. 68 ± 33. 27） minutes,longer than（ 82. 99 ± 17. 62） minutes in the AM group（ P〈0. 05）. After compared the postoperative clinical situation of the two groups,patients in the LM group who had a fever accounting for 10. 5%（ 12/114）,significantly lower than 39. 2%（ 38/97） of the AM group. The number of patients with anal exhaust within 24 hours accounting for 83. 3%（ 95/114）,significantly higher than 52. 6%（ 51/97） of AM group. The use of analgesics was 18. 4%（ 21/114）,significantly lower than 34. 0%（ 33/97） in AM group. Postoperative hospitalization time was（ 4. 05 ±1. 79） days,significantly shorter than（ 7. 47 ± 2. 22） days of AM group（ P〈0. 05）. Postoperative pregnancy outcomes comparison showed that induced abortionof 9. 5%（ 4/42） patients in the LM group were effected,induced abortion of 20. 6%（ 7/34） patients in the AM group were effected（ P〈0. 05）. Compared the postoperative pregnancy,16. 7%（ 6/36） of the LM group had vaginal delivery,and 83. 3%（ 30/36） of the patients had cesarean section. In the AM group,8. 0%（ 2/25） had vaginal delivery,and 92. 0%（ 23/25）had cesarean section（ P〈0. 05）. The
出处
《临床军医杂志》
CAS
2018年第2期175-178,182,共5页
Clinical Journal of Medical Officers
