腹腔镜子宫肌瘤剔除术与开腹子宫肌瘤切除术治疗子宫肌瘤疗效比较
|
摘要
目的比较腹腔镜子宫肌瘤剔除术与开腹子宫肌瘤切除术治疗子宫肌瘤的临床效果。方法选择2015年1月至2017年2月阜宁县人民医院收治的98例子宫肌瘤患者为研究对象,按照手术方法将患者分为腹腔镜手术组和开腹手术组,每组49例。开腹手术组患者行开腹子宫肌瘤切除术,腹腔镜手术组患者行腹腔镜子宫肌瘤剔除术。观察2组患者的手术情况、术后恢复情况及术后并发症,术后第3天采用视觉模拟评分法(VAS)对患者术后疼痛进行评估。所有患者术后随访1 a,观察子宫肌瘤复发情况,并采用生活质量综合评定问卷评估患者生活质量。结果与开腹手术组比较,腹腔镜手术组患者手术时间长,术中出血量少,术后肛门排气时间和住院时间短,VAS评分低(P <0. 05)。腹腔镜手术组和开腹手术组患者术后并发症发生率分别为4. 08%、22. 45%,腹腔镜手术组患者术后并发症发生率低于开腹手术组(P <0. 05)。术后1 a,腹腔镜手术组和开腹手术组患者子宫肌瘤复发率分别为2. 04%、14. 29%,腹腔镜手术组患者子宫肌瘤复发率低于开腹手术组(P <0. 05)。腹腔镜手术组患者的物质生活条件、躯体功能、心理功能、社会功能评分及生活质量总分均高于开腹手术组(P <0. 05)。结论腹腔镜子宫肌瘤剔除术治疗子宫肌瘤创伤小,术后恢复快,且并发症发生率和子宫肌瘤复发率低,患者生活质量高。
Objective To compare the clinical effect of laparoscopic hysteromyomectomy and abdominal hysteromyomectomy in the treatment of hysteromyoma. Methods A total of 98 patients with hysteromyoma in the People's Hospital of Funing County from January 2015 to February 2017 were selected as the study subjects. The patients were divided into laparoscopic operation group and laparotomy group according to operation method,49 cases in each group. The patients in the laparotomy group were performed with abdominal hysteromyomectomy,while the patients in the laparoscopic operation group underwent laparoscopic hysteromyomectomy. The operation condition,postoperative recovery and postoperative complications of the patients in the two groups were observed. The pain of the patients was evaluated by visual analogue scale( VAS) on the third day after operation. All patients were followed up for one year,and the recurrence of hysteromyoma was observe,the quality of life was assessed by GQOLI-74. Results Compared with the laparotomy group,the operation time was longer,the intraoperative bleeding was less,the postoperative anal exhaust time and hospitalization time were shorter,and the VAS score was lower in the laparoscopic operation group( P < 0. 05). The incidence of complications in the laparoscopic group and laparotomy group was 4. 08% and 22. 45%,respectively. The incidence of complications in the laparoscopic group was lower than that in the laparotomy group( P < 0. 05). Within one year after operation,the recurrence rate of hysteromyoma in the laparoscopic group and laparotomy group was 2. 04% and 14. 29%,respectively. The recurrence rate of hysteromyoma in the laparoscopic group was lower than that in the laparotomy group( P < 0. 05). The scores of material life condition,physical function,psychological function,social function and the total score of quality of life in the laparoscopic group were higher than those in the laparotomy group( P < 0. 05). Conclusion Laparoscopic hysteromyomectomy in the treatment of hysteromyoma has less trauma,faster postoperative recovery,lower complication incidence and hysteromyoma recurrence rate,and higher quality of life.
Objective To compare the clinical effect of laparoscopic hysteromyomectomy and abdominal hysteromyomectomy in the treatment of hysteromyoma. Methods A total of 98 patients with hysteromyoma in the People's Hospital of Funing County from January 2015 to February 2017 were selected as the study subjects. The patients were divided into laparoscopic operation group and laparotomy group according to operation method,49 cases in each group. The patients in the laparotomy group were performed with abdominal hysteromyomectomy,while the patients in the laparoscopic operation group underwent laparoscopic hysteromyomectomy. The operation condition,postoperative recovery and postoperative complications of the patients in the two groups were observed. The pain of the patients was evaluated by visual analogue scale( VAS) on the third day after operation. All patients were followed up for one year,and the recurrence of hysteromyoma was observe,the quality of life was assessed by GQOLI-74. Results Compared with the laparotomy group,the operation time was longer,the intraoperative bleeding was less,the postoperative anal exhaust time and hospitalization time were shorter,and the VAS score was lower in the laparoscopic operation group( P < 0. 05). The incidence of complications in the laparoscopic group and laparotomy group was 4. 08% and 22. 45%,respectively. The incidence of complications in the laparoscopic group was lower than that in the laparotomy group( P < 0. 05). Within one year after operation,the recurrence rate of hysteromyoma in the laparoscopic group and laparotomy group was 2. 04% and 14. 29%,respectively. The recurrence rate of hysteromyoma in the laparoscopic group was lower than that in the laparotomy group( P < 0. 05). The scores of material life condition,physical function,psychological function,social function and the total score of quality of life in the laparoscopic group were higher than those in the laparotomy group( P < 0. 05). Conclusion Laparoscopic hysteromyomectomy in the treatment of hysteromyoma has less trauma,faster postoperative recovery,lower complication incidence and hysteromyoma recurrence rate,and higher quality of life.
引文
[1]薛文丹,邢孔丽,李小清.腹腔镜超声辅助在子宫肌瘤患者微创手术中的应用研究[J].中国内镜杂志,2017,23(11):46-50.
[2]俞梅,朱兰,郎景和. GnRHa用于大子宫子宫肌瘤腹腔镜手术前治疗疗效的前瞻性研究[J].实用妇产科杂志,2014,30(8):588-591.
[3] BOURDEL N,COLLINS T,PIZARRO D,et al. Use of augmented reality in laparoscopic gynecology to visualize myomas[J]. Fertil Steril,2017,107(3):737-739.
[4]杨晓歆.应用VAS评分尽早对开胸术后患者实施疼痛干预的护理[J].国际护理学杂志,2014,33(11):3031-3033.
[5]殷美静,张纯溪,张萍.大孕周子宫肌瘤患者行腹腔镜下子宫肌瘤剔除术前后GnRH-a的应用价值[J].山东医药,2016,56(45):62-64.
[6]李文霞,陈德娟,颜爱华,等.腹腔镜辅助阴式全子宫切除术在巨大子宫肌瘤治疗中的应用价值[J].现代生物医学进展,2015,15(2):312-315.
[7]王细拉.宫腔镜联合腹腔镜对子宫肌瘤患者炎性应激反应及生活质量的影响[J].中国老年学杂志,2016,36(24):6226-6228.
[8]董潇楠.经阴道手术与腹腔镜手术治疗子宫肌瘤疗效对比观察[J].山东医药,2014,54(18):53-54.
[9] KARAMANOU M,SALAKOS N,GRAMMATIKAKIS I,et al. Hallmarks in the evolution of gynaecological cancer surgery:the famous pioneers in children[J]. J BUON,2017,22(6):1613-1616.
[10]迟新红,贾桂英.阴式子宫肌瘤剥除术及腹腔镜下子宫肌瘤剥除术两种微创术式的效果观察[J].中国妇幼保健,2014,29(13):2128-2129.
[2]俞梅,朱兰,郎景和. GnRHa用于大子宫子宫肌瘤腹腔镜手术前治疗疗效的前瞻性研究[J].实用妇产科杂志,2014,30(8):588-591.
[3] BOURDEL N,COLLINS T,PIZARRO D,et al. Use of augmented reality in laparoscopic gynecology to visualize myomas[J]. Fertil Steril,2017,107(3):737-739.
[4]杨晓歆.应用VAS评分尽早对开胸术后患者实施疼痛干预的护理[J].国际护理学杂志,2014,33(11):3031-3033.
[5]殷美静,张纯溪,张萍.大孕周子宫肌瘤患者行腹腔镜下子宫肌瘤剔除术前后GnRH-a的应用价值[J].山东医药,2016,56(45):62-64.
[6]李文霞,陈德娟,颜爱华,等.腹腔镜辅助阴式全子宫切除术在巨大子宫肌瘤治疗中的应用价值[J].现代生物医学进展,2015,15(2):312-315.
[7]王细拉.宫腔镜联合腹腔镜对子宫肌瘤患者炎性应激反应及生活质量的影响[J].中国老年学杂志,2016,36(24):6226-6228.
[8]董潇楠.经阴道手术与腹腔镜手术治疗子宫肌瘤疗效对比观察[J].山东医药,2014,54(18):53-54.
[9] KARAMANOU M,SALAKOS N,GRAMMATIKAKIS I,et al. Hallmarks in the evolution of gynaecological cancer surgery:the famous pioneers in children[J]. J BUON,2017,22(6):1613-1616.
[10]迟新红,贾桂英.阴式子宫肌瘤剥除术及腹腔镜下子宫肌瘤剥除术两种微创术式的效果观察[J].中国妇幼保健,2014,29(13):2128-2129.