目的 比较子宫肌瘤两种切除术式对妊娠结局的效果。方法 回顾性分析2012-01至2014-06我科收治的240例因子宫肌瘤行手术治疗且有生育要求的患者的临床资料,按照手术方式将其分为腹腔镜组(128例)和开腹组(112例),观察两组患者子宫肌瘤的类型、位置、大小、数目和妊娠结局等情况,分析不同术式对患者妊娠的影响。结果 随访至2015年12月,开腹组切除子宫肌瘤直径[(7.6±3.0)cm、肌瘤数目(5.6±5.5)个]均高于腹腔镜组[ (6.8±2.0)cm、(2.4±2.1)个],差异有统计学意义(P<0.05);而子宫肌瘤的类型,腹腔镜组更多为浆膜下肌瘤,开腹组则更多为肌壁间肌瘤及黏膜下肌瘤;腹腔镜组与开腹组患者术后妊娠率分别为64.8%、62.5%,流产率分别为9.38%、7.14％,早产率分别为6.25%、4.46%,这3个率两组比较,差异均无统计学意义,且两组患者术后妊娠均未发生子宫破裂。结论 开腹和腹腔镜下子宫肌瘤切除术对于有生育要求的子宫肌瘤患者均行之有效,可获得满意的妊娠结局。
Abstract
Objective To study pregnancy outcome of laparoscopic hystero myomectomy(LM)and trans abdominal hystero myomectomy(TAM).Methods The clinical medical records of 240 patients with fertility demands after hystero myomectomy and delivered from January 2012 to June 2014 in this hospitalwere reviewed retrospectively. They were divided into laparoscopic group (128 cases)and laparotomy group(112 cases) according to operation method. Leiomyoma’s characteristics and pregnancy outcome were analyzed in LM and TAM groups respectively.Results Followed-up to December 2015, the diameter, mean numbers of leiomyoma removed were smaller in the LM group[(6.8±2.0)cm、(2.4±2.1),respectively] than those in the TAM group[(7.6±3.0)cm,(5.6±5.5),respectively; P<0.05)].For the type of uterine fibroids, there were more subserosal fibroids in the LM group, and there were more intramural fibroids and submucosal fibroids in the TAM group. However, the pregnancy rate of LM and TAM was 64.8% versus 62.5% respectively; the incidence of abortion of LM and TAM was 9.38% versus 7.14％respectively; the incidence of premature birth of LM and TAM was 6.25% versus 4.46% respectively. No uterine rupture occurred during pregnancy.Conclusions Both the LM and TAM are proved to be effective and feasible Methods for females who have fertility requirements but suffer from leiomyoma.
关键词
开腹 /
腹腔镜 /
子宫肌瘤切除术 /
妊娠结局
Key words
laparotomy /
laparoscopic /
myomectomy /
pregnancy outcome
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