腹腔镜子宫肌瘤剔除术与经腹子宫肌瘤剔除术对子宫肌瘤的临床效果及安全性分析.pdf
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1、60中国现代药物应用2023年9月第17卷第18期Chin J Mod Drug Appl,Sep 2023,Vol.17,No.18腹腔镜子宫肌瘤剔除术与经腹子宫肌瘤剔除术对 子宫肌瘤的临床效果及安全性分析张明【摘要】目的研究腹腔镜子宫肌瘤剔除术与经腹子宫肌瘤剔除术对子宫肌瘤的临床效果及安全性。方法100 例子宫肌瘤患者,按照随机数字表法分为对照组和观察组,每组 50 例。对照组实施经腹子宫肌瘤剔除术治疗,观察组实施腹腔镜子宫肌瘤剔除术治疗。比较两组手术指标、住院时间、临床疗效、并发症发生情况及手术前后应激指标肾上腺素(E)、去甲肾上腺素(NE)和卵巢功能指标促卵泡刺激素(FSH)、雌二醇(
2、E2)、促黄体生成素(LH)。结果观察组术中出血量(77.3910.13)ml 少于对照组(100.6015.73)ml,手术时间(64.724.48)min、术后肛门排气时间(18.082.14)h、住院时间(5.671.05)d 均短于对照组的(81.546.69)min、(31.353.58)h、(10.562.14)d,差异具有统计学意义(P0.05)。术后 1 d,两组 E、NE、FSH、LH 水平均高于本组术前 1 d,E2水平低于本组术前 1 d,但观察组 E(108.0115.63)pmol/L、NE(400.2143.56)pmol/L、FSH(21.082.65)U/L、L
3、H(18.782.60)U/L 低于对照组的(175.3518.76)pmol/L、(533.7563.80)pmol/L、(27.293.37)U/L、(23.353.42)U/L,E2(241.838.36)pmol/L 高于对照组的(222.6910.52)pmol/L,差异具有统计学意义(P0.05)。观察组治疗总有效率为96.00%,高于对照组的82.00%,差异具有统计学意义(P0.05)。观察组并发症发生率为6.00%,低于对照组的 20.00%,差异具有统计学意义(P0.05)。结论子宫肌瘤患者接受腹腔镜子宫肌瘤剔除术治疗的有效性及安全性均较经腹子宫肌瘤剔除术更高,应激反应更轻
4、,对卵巢功能的影响小,值得临床推广应用。【关键词】子宫肌瘤;腹腔镜子宫肌瘤剔除术;经腹子宫肌瘤剔除术;卵巢功能DOI:10.14164/11-5581/r.2023.18.015Clinical effect and safety analysis of laparoscopic and transabdominal myomectomy for uterine fibroids ZHANG Ming.Department of Obstetrics and Gynecology,The Second Peoples Hospital of Wuxue,Wuxue 435411,China【A
5、bstract】Objective To study the clinical effect and safety of laparoscopic and transabdominal myomectomy for uterine fibroids.Methods A total of 100 patients with uterine fibroids were divided into control group and observation group according to the random numerical table,with 50 cases in each group
6、.The control group was treated with transabdominal myomectomy,and the observation group was treated with laparoscopic myomectomy.Both groups were compared in terms of surgical indexes,length of hospital stay,clinical efficacy,complications,stress indexes epinephrine(E),noradrenaline(NE)and ovarian f
7、unction indexes follicle-stimulating hormone(FSH),estradiol(E2),luteinizing hormone(LH)before and after surgery.Results The intraoperative blood loss of(77.3910.13)ml in the observation group was less than that of(100.6015.73)ml in the control group;in the observation group,the operative time was(64
8、.724.48)min,the postoperative anal exhaust time was(18.082.14)h,and the length of hospital stay was(5.671.05)d,which were shorter than those of(81.546.69)min,(31.353.58)h,and(10.562.14)d in the control group;the differences were statistically significant(P0.05).At 1 d after surgery,E,NE,FSH,LH level
9、s in both groups were higher than those at 1 d before surgery,and E2 level was lower than that at 1 d before surgery;the observation group had E of(108.0115.63)pmol/L,NE of(400.2143.56)pmol/L,FSH of(21.082.65)U/L,and LH of(18.782.60)U/L,which were lower than those of(175.3518.76)pmol/L,(533.7563.80)
10、pmol/L,(27.293.37)U/L,and(23.353.42)U/L in the control group;E2 of(241.838.36)pmol/L in the observation group was higher than that of(222.6910.52)pmol/L in the control group;the differences were statistically significant(P0.05).The total effective rate of the observation group was 96.00%,which was h
11、igher than that of 82.00%of the control group,and the difference was statistically significant(P0.05).The incidence of complications in the observation group was 6.00%,which was lower than that of 20.00%in the control group,and the difference was statistically significant(P0.05),具有可比性。1.2纳入及排除标准1.2.
12、1纳入标准符合子宫肌瘤的诊治中国专家共识中有关诊断标准者;经影像学检查、病理学检查证实为子宫肌瘤者;具备子宫肌瘤剔除术指 征者。1.2.2排除标准存在心、肝、肾、甲状腺等脏器系统原发性疾病者;存在卵巢囊肿、子宫内膜癌等其他妇科疾病者;存在免疫缺陷、凝血机制异常者;合并癌症者;存在沟通交流障碍、精神异常者。1.3方法两组患者术前均通过影像学检查确定子宫肌瘤的位置,做好肠道准备,并对阴道进行清洁。1.3.1对照组患者实施经腹子宫肌瘤剔除术治疗。患者取仰卧位,行气管插管全身麻醉(全麻),于下腹部作一 68 cm 左右的切口,仔细探查腹腔,将子宫浆肌层切开,应用钳夹提拉肌瘤,将肌瘤与周围组织钝性分离,
13、将肌瘤完整剔除,将子宫复位,对盆腔应用生理盐水进行冲洗,充分止血后关腹。1.3.2观察组患者实施腹腔镜子宫肌瘤剔除术治疗。患者取膀胱截石位,予以全麻,在脐轮上缘作 higher efficacy and safety,lighter stress reaction and less impact on ovarian function,which is worthy of clinical promotion and application.【Key words】Uterine fibroids;Laparoscopic myomectomy;Transabdominal myomectomy
14、;Ovarian function1 cm 的纵行切口,气腹针穿刺后建立二氧化碳气腹,气腹压维持在 14 mm Hg(1 mm Hg=0.133 kPa),将气腹针拔出。采用四孔法,将腹腔镜及手术器械置入,明确子宫肌瘤情况。对于肌壁间肌瘤,在子宫肌瘤最突出位置注入垂体后叶素 12 U,将突起部位切开,在腹腔镜引导下完整剔除子宫肌瘤,缝合子宫,电凝止血后应用生理盐水对盆腔进行冲洗。对于浆膜下肌瘤,若子宫肌瘤蒂粘结子宫,则需先在肌瘤蒂部打结,在打结上 0.5 cm 处将子宫肌瘤剔除;在无子宫肌瘤蒂的情况下,将子宫肌瘤包膜环形切开,剔除子宫肌瘤后将子宫缝合。对于阔韧带肌瘤,明确输尿管、圆韧带位置,于
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- 腹腔镜 子宫 肌瘤 剔除 临床 效果 安全性 分析