腹腔镜下子宫动脉阻断后子宫肌瘤剔除与腹腔镜下子宫肌瘤剔除的临床比较研究

发布时间：2018-02-27 13:57

本文关键词： 腹腔镜子宫动脉阻断子宫肌瘤子宫肌瘤剔除　出处：《苏州大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：分析腹腔镜下子宫动脉阻断后行子宫肌瘤剔除术与腹腔镜下子宫肌瘤剔除术在临床的治疗效果,探讨预先阻断子宫动脉在腹腔镜下子宫肌瘤剔除术中的临床应用价值。方法：选取苏州大学附属第二医院和苏州市中西医结合医院两所医院同期收治的子宫肌瘤患者103例,均要求保留子宫而行子宫肌瘤剔除,随机分成2组,研究组63例(多发性子宫肌瘤34例,单发性子宫肌瘤29例),腹腔镜下预先处理子宫动脉,后行子宫肌瘤剔除(LUAO-M)。在腹腔镜下分离解剖子宫动脉主干,闭合子宫动脉,然后单极电凝钩切开肌瘤表面包膜,剥离、剔除肌瘤,连续缝合子宫表面浆肌层切口；对照组40例(多发性子宫肌瘤21例,单发性子宫肌瘤19例)。按常规在腹腔镜下子宫肌瘤剔除(LM)。比较两组在手术时间、术中出血量、住院日等方面的差异。结果：腹腔镜下子宫动脉阻断后行子宫肌瘤剔除术,虽手术时间略长,但术中出血量少于腹腔镜下单纯肌瘤剔除,尤其是在多发性子宫肌瘤手术中。在子宫肌瘤直径大于7cm的肌瘤腹腔镜剔除术中,多发性子宫肌瘤手术时间长,但出血少；单发肌瘤手术时间两组无差异,子宫动脉阻断组术中出血少。子宫动脉阻断组术后月经量减少,症状改善,肌瘤复发率低。两组在术后平均住院天数、术后病率、排气时间等无统计学差异。结论： 1、腹腔镜下子宫动脉阻断后行子宫肌瘤剔除可以减少手术中出血,保留子宫,抑制肌瘤复发。 2、拓宽腹腔镜下子宫肌瘤剔除适应症,减少术后并发症,提高手术质量,改善术后症状。 3、虽该手术方式技术要求高,但值得推广。
[Abstract]:Objective: to analyze the clinical effect of uterine myomectomy and laparoscopic hysteromyomectomy after laparoscopic uterine artery occlusion, and to explore the clinical value of pre-blocking uterine artery in laparoscopic hysteromyomectomy. Methods: one hundred and three patients with uterine leiomyoma treated in the second affiliated Hospital of Suzhou University and Suzhou Integrated Chinese and Western Medicine Hospital were randomly divided into two groups. In the study group, 63 cases (34 cases of multiple hysteromyoma and 29 cases of single uterine leiomyoma) were treated with laparoscope to treat the uterine artery, and then the uterine artery was dissected and the uterine artery was closed. Then the monopole hook cut through the surface of the myoma, stripped it, removed it, and sutured the sarcoplasmic myometrium incision on the surface of the uterus, while in the control group, there were 40 cases (21 cases of multiple myoma of the uterus). 19 cases of single uterine leiomyoma were removed by laparoscope. The difference of operation time, intraoperative bleeding volume and hospitalization time were compared between the two groups. Results: hysteromyomectomy was performed under laparoscopic uterine artery occlusion. Although the operative time was a little longer, the amount of intraoperative bleeding was less than that of simple myomectomy under laparoscope. Especially in multiple hysteromyoma surgery, the operation time of multiple hysteromyoma was longer than 7 cm, but the bleeding was less, there was no difference between the two groups in the operation time of single myoma. Uterine artery occlusion group had less bleeding, less menstrual volume, improved symptoms and lower recurrence rate of myoma. There was no significant difference between the two groups in average hospital stay, postoperative disease rate, exhaust time and so on. Conclusion:. 1.Laparoscopic uterine artery occlusion after uterine myomectomy can reduce bleeding, preserve the uterus, and inhibit the recurrence of myoma. 2, broaden the indications of laparoscopic hysteromyoma removal, reduce postoperative complications, improve the quality of surgery and improve postoperative symptoms. 3, although the technical requirements of the operation is high, but it is worth popularizing.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33

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