卡孕栓在腹腔镜下子宫肌瘤剔除术中的应用价值

发布时间：2018-04-06 07:08

本文选题：卡孕栓　切入点：腹腔镜　出处：《青岛大学》2017年硕士论文

【摘要】：子宫肌瘤(uterus myoma),亦称子宫平滑肌瘤(uterus leiomyoma)。其中,约1/3的患者表现为月经过多及盆腔压迫症状需行手术治疗。对于有生育要求的患者腹腔镜下子宫肌瘤剔除术(Laparoscopic myomectomy)是首选治疗方法。而手术的安全性及有效性关键在于控制术中出血。同时,手术者娴熟的缝合技巧及与助手高度的配合也可见减少术中失血量及输血率,当然,结合其他减少术中出血的方法效果会更好。本研究诣在为卡孕栓在腹腔镜下子宫肌瘤剔除术中的临床应用提供理论依据。目的:评估卡孕栓在腹腔镜下子宫肌瘤剔除术中(Laparoscopic myomectomy)使用的有效性、安全性及可行性。方法:选取2016年1月至2016年6月在青岛市妇女儿童医院妇科中心因子宫肌瘤选择行腹腔镜下子宫肌瘤剔除术的80名患者为研究对象,将其随机分为A组(卡孕栓组)40例(多发性子宫肌瘤22例,单发性子宫肌瘤18例),全身麻醉成功后阴道后穹窿放置卡孕栓2枚(东北制药总厂)(1.0mg);B组(垂体后叶素组)40例(多发性子宫肌瘤23例,单发性子宫肌瘤17例),术中在切开子宫浆膜层前于子宫肌瘤瘤体与子宫肌层交界处注射垂体后叶素6IU+0.9%氯化钠注射液l0ml。两组患者均在气管插管全麻下行腹腔镜下子宫肌瘤剔除术。比较两组术中出血量、手术时间、术前/后血红蛋白差值的改变、收缩压、舒张压和心率的变化(包括用药前、用药后10min、用药后30min、术后3天)以及术后胃肠道功能恢复情况。结果:两组均顺利完成手术,术中无周围脏器损伤(膀胱、输尿管、直肠等损伤),术中无中转开腹,术后无大出血。1.两组患者术中出血量分别为84.7±63.9ml、87.1±52.6ml,手术前后血红蛋白的差值分别为22.3±17.0g/L、19.3±20.6g/L,平均手术时间是93.3±40.0min、117.3±37.9min,A组术中出血量、手术前后血红蛋白的差值、手术时间与B组无显著差异(P均0.05)。2.两组患者术后平均排气时间分别为27.2±2.79h、36.1±4.21h,A组术后排气时间明显短于B组,差异有统计学意义(t=11.11,P0.05)。3.B组患者用药后10min的收缩压、舒张压及心率明显升高,用药后30min血压和心率恢复正常,A组术中对血液动力学的影响小,明显优于B组(两组各时间点收缩压的比较:F=43.0,P0.05;两组各时间点舒张压的比较:F=64.2,P0.05;两组各时间点心率的比较:F=56.2,P0.05)。结论:1.卡孕栓及垂体后叶素在腹腔镜下子宫肌瘤剔除术术中出血量、手术前后血红蛋白差值、手术时间方面无显著差异。2.卡孕栓对胃肠功能及血流动力学影响方面优于垂体后叶素。3.在腹腔镜下子宫肌瘤剔除术中阴道后穹窿放置卡孕栓操作简便、安全有效,副作用小,值得在临床工作中推广应用。
[Abstract]:Uterine leiomyoma, also known as uterine leiomyoma.About a third of the patients had menorrhagia and pelvic compression symptoms that required surgical treatment.Laparoscopic hysteromyomectomy is the first choice of treatment for patients with fertility requirements.The key to the safety and effectiveness of the operation is to control intraoperative bleeding.At the same time, the skillful suture skill and the high cooperation with assistant can also reduce the amount of blood loss and blood transfusion rate, of course, combined with other methods to reduce intraoperative bleeding will be more effective.The purpose of this study is to provide theoretical basis for clinical application of pregnancy card suppository in laparoscopic hysteromyomectomy.Objective: to evaluate the efficacy, safety and feasibility of pregnancy suppository in laparoscopic hysteromyomectomy.Methods: from January 2016 to June 2016, 80 patients who underwent laparoscopic hysteromyomectomy at the gynecological center of Qingdao Women and Children's Hospital were selected as the study objects.They were randomly divided into two groups: group A (40 cases with multiple uterine leiomyoma, 22 cases with multiple uterine leiomyoma).There were 18 cases of single uterine leiomyoma, 2 pregnant suppositories were placed in the posterior fornix of vagina after general anesthesia (group B: 1.0 mg / L) (group B) (40 cases of pituitary fibroin group (23 cases of multiple uterine leiomyoma).17 cases of single uterine leiomyoma were treated with hypophysin 6IU 0.9% sodium chloride injection 10 ml before incision of uterine serous layer at the junction between uterine fibroid tumor and myometrium.Both groups underwent laparoscopic hysteromyomectomy under tracheal intubation and general anesthesia.The changes of blood loss, operation time, hemoglobin difference before and after operation, systolic blood pressure, diastolic blood pressure and heart rate were compared between the two groups (including before, 10 min after medication, 30 min after treatment, 3 days after operation) and the recovery of gastrointestinal function after operation.Results: the operation was successfully completed in both groups. There were no perioperative organ injuries (bladder, ureter, rectum, etc.), no conversion to laparotomy, and no massive bleeding after operation.The mean postoperative exhaust time of the two groups was 27.2 卤2.79 hours and 36.1 卤4.21 hours respectively, which was significantly shorter than that in group B, and the difference was statistically significant. The systolic blood pressure, diastolic pressure and heart rate of 10min in group B were significantly higher than those in group B.The effect of 30min blood pressure and heart rate on hemodynamics in group A was less than that in group B (the comparison of systolic blood pressure at each time point in two groups was 43.0% P0.05; the comparison of diastolic blood pressure at different time points in two groups was: FN 64.2% P0.05; the comparison of heart rate between two groups at different time points: F56.2P0.05g).Conclusion 1.There was no significant difference in blood loss, hemoglobin difference before and after operation and operative time between the two groups in laparoscopic hysteromyomectomy.The effect of carbopregnancy suppository on gastrointestinal function and hemodynamics was superior to that of pituitrin. 3.It is simple, safe and effective to place pregnancy embolus in posterior fornix of vagina during laparoscopic hysteromyomectomy, so it is worth popularizing in clinical work.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

【参考文献】