垂体后叶素不同剂量及其注射方式对腹腔镜下子宫肌瘤剔除术的临床疗效
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摘要
目的比较垂体后叶素不同剂量、不同注射方案对腹腔镜下子宫肌壁间肌瘤剔除术的临床疗效及对循环系统的影响。方法选取2015~2016年在简阳市人民医院接受腹腔镜下子宫肌瘤剔除术的420例患者作为研究对象,按随机数字表法分为对照组与观察组,各210例,对照组采取直接剥离法,观察组采取垂体后叶素液体分离法;另观察组根据注射方式及剂量不同分为3个亚组,各70例,A亚组(6 U一次注射)、B亚组(6 U分两次注射)、C亚组(12 U一次注射);比较两组的手术时间、术中出血量、用药前后血压变化、手术前后血红蛋白变化、术后肛门排气时间、术后抗生素使用时间、术后住院时间及并发症发生情况等指标。结果观察组术中出血量、手术时间及术后住院时间均显著少于对照组(P<0.05);观察组垂体后叶素注射后10 min收缩压显著上升,收缩压变化明显高于对照组(P<0.05);观察组术后血红蛋白下降值、抗生素使用时间均明显少于对照组(P<0.05);观察组各亚组间比较,B亚组术中出血量、术后血压波动情况及术后血红蛋白下降值方面均优于A亚组和C亚组,差异有统计学意义(P<0.05)。结论腹腔镜下行子宫肌瘤剔除术应用小剂量分次注射垂体后叶素液体分离法,能够显著减少术中出血,有效缩短手术时间、抗生素使用时间及住院时间,利于患者术后恢复,值得临床推广。
Objective To compare the clinical effects of different doses of pituitrin and different injection methods on laparoscopic myomectomy and its influence on circulatory system.Methods From 2015 to 2016,420 patients underwent laparoscopic myomectomy in the People's Hospital of Jianyang City were selected as the study subjects.They were randomly divided into control group and observation group,each with 210 cases.The control group was treated with direct stripping method and the observation group was treated with pituitrin liquid separation method.According to the observation group's injection method and measurement,they were divided into three subgroups: 70 cases,A subgroup( one injection fo 6 U),B subgroup( two injections of 6 U),and C subgroup( one injection of 12 U); The operation time,intraoperative blood loss,blood pressure changes before and after medication,hemoglobin changes before and after surgery,postoperative anal exhaust time,postoperative antibiotic use time,postoperative hospital stay and complications were compared between the two groups.Results The intraoperative blood loss,the time of operation and the time of hospitalization were significantly lower in the observation group than in the control group( P < 0.05).The systolic blood pressure of the observation group was significantly increased at 10 min after injection of pituitrin,and the systolic blood pressure was significantly higher than that of the control group( P < 0.05).The decrease of hemoglobin and the time of antibiotic use in the observation group were significantly lower than those in the control group( P < 0.05).The intraoperative blood loss,postoperative blood pressure fluctuation and postoperative hemoglobin decline in B subgroup were superior to subgroup A and C subgroup,the differences were statistically significant( P < 0.05).Conclusion Laparoscopic myomectomy with low dose fractional injection of pituitrin liguid separation can be used to reduce the intraoperative bleeding,reduce the operation time,antibiotic use time and discharge time,which is beneficial to the postoperative recovery of patients.It is worthy of clinical promotion.
Objective To compare the clinical effects of different doses of pituitrin and different injection methods on laparoscopic myomectomy and its influence on circulatory system.Methods From 2015 to 2016,420 patients underwent laparoscopic myomectomy in the People's Hospital of Jianyang City were selected as the study subjects.They were randomly divided into control group and observation group,each with 210 cases.The control group was treated with direct stripping method and the observation group was treated with pituitrin liquid separation method.According to the observation group's injection method and measurement,they were divided into three subgroups: 70 cases,A subgroup( one injection fo 6 U),B subgroup( two injections of 6 U),and C subgroup( one injection of 12 U); The operation time,intraoperative blood loss,blood pressure changes before and after medication,hemoglobin changes before and after surgery,postoperative anal exhaust time,postoperative antibiotic use time,postoperative hospital stay and complications were compared between the two groups.Results The intraoperative blood loss,the time of operation and the time of hospitalization were significantly lower in the observation group than in the control group( P < 0.05).The systolic blood pressure of the observation group was significantly increased at 10 min after injection of pituitrin,and the systolic blood pressure was significantly higher than that of the control group( P < 0.05).The decrease of hemoglobin and the time of antibiotic use in the observation group were significantly lower than those in the control group( P < 0.05).The intraoperative blood loss,postoperative blood pressure fluctuation and postoperative hemoglobin decline in B subgroup were superior to subgroup A and C subgroup,the differences were statistically significant( P < 0.05).Conclusion Laparoscopic myomectomy with low dose fractional injection of pituitrin liguid separation can be used to reduce the intraoperative bleeding,reduce the operation time,antibiotic use time and discharge time,which is beneficial to the postoperative recovery of patients.It is worthy of clinical promotion.
引文
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[13]张翠萍.腹腔镜下与经腹子宫肌瘤剔除手术对子宫肌瘤患者的效果比较[J].医学综述,2015,21(22):4173-4175.
[14]吴燕祯,秦福杰,李玉香,等.腹腔镜下卵巢囊肿剥除创面双极电凝止血与缝合止血对卵巢功能影响[J].中国医刊,2015,50(4):66-69.
[15]HALD K,NORENG H J,ISTRE O,et al.Uterine artery embolization versus laparoscopic occlusion of uterine arteries for leiomyomas:long-term results of a randomized comparative trial[J].Journal of Vascular and Interventional Radiology,2009,20(10):1303-1311.
[16]余红,祖恩慧.垂体后叶素联合肌瘤蒂部套扎在腹腔镜子宫肌瘤剔除术中的止血效果分析[J].广西医学,2015,37(10):1504-1505,1514.
[17]蒋秋敏.不同方法给予垂体后叶素对子宫肌瘤切除术中循环系统的影响[J].中国煤炭工业医学杂志,2015,18(6):918-920.
[18]努尔买买提江·买合木提,穆哈塔尔·热西提,尚何提,等.不同剂量垂体后叶素对腹腔镜子宫肌瘤剔除术中循环的影响[J].中国肿瘤临床与康复,2013,20(8):841-843.
[19]马建芳,秦嶽,张亚萍.间隔注射垂体后叶素联合套扎止血法在腹腔镜下子宫肌瘤切除术中的应用效果及对循环系统的影响[J].广西医科大学学报,2016,33(4):657-660.
[2]蔡兴苑,卢丹,魏薇,等.子宫肌瘤剔除术后复发情况及相关危险因素分析[J].实用妇产科杂志,2015,31(5):358-360.
[3]IKEDA M,ISHIDA H,NAITO Y,et al.A patient who was found to be pregnant unexpectedly during hysteromyomectomy[J].International Journal of Obstetric Anesthesia,1999,8(3):189-190.
[4]陆宏,刘佳,王晓彬,等.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患者术后妊娠的影响[J].中国医药导报,2015,12(12):102-106,111.
[5]蔡兴苑,卢丹,代荫梅,等.腹腔镜子宫肌瘤剔除术后影响患者妊娠结局的多因素分析[J].中国微创外科杂志,2015,15(9):769-772.
[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]龚瑶,何英第,陈锦云,等.超声消融与腹腔镜手术治疗子宫肌瘤的临床对比研究[J].激光杂志,2015,36(2):153-154.
[8]AMELOOT R,LIEKENS A,ALAERTS L,et al.Silica-MOF composites as a stationary phase in liquid chromatography[J].European Journal of Inorganic Chemistry,2010(24):3735-3738.
[9]王丹丹,杨清.腹腔镜子宫肌瘤剔除术的相关问题及其处理[J].中国实用妇科与产科杂志,2015,31(5):399-402.
[10]冯志敏.微创技术对治疗症状性子宫肌瘤的临床意义[J].中国性科学,2012,21(10):29-31.
[11]Yamaguchi M,Yabuta M,Kishi Y,et al.Factors being related to operation time and complications in laparoscopic myomectomy:a retrospective study[J].Advances in Obstetrics&Gynecology,2014,66:71-77.
[12]SIZZI O,ROSSETTI A,MALZONI M,et al.Italian multicenter study on complications of laparoscopic myomectomy[J].Journal of Minimally Invasive Gynecology,2007,14(4):453-462.
[13]张翠萍.腹腔镜下与经腹子宫肌瘤剔除手术对子宫肌瘤患者的效果比较[J].医学综述,2015,21(22):4173-4175.
[14]吴燕祯,秦福杰,李玉香,等.腹腔镜下卵巢囊肿剥除创面双极电凝止血与缝合止血对卵巢功能影响[J].中国医刊,2015,50(4):66-69.
[15]HALD K,NORENG H J,ISTRE O,et al.Uterine artery embolization versus laparoscopic occlusion of uterine arteries for leiomyomas:long-term results of a randomized comparative trial[J].Journal of Vascular and Interventional Radiology,2009,20(10):1303-1311.
[16]余红,祖恩慧.垂体后叶素联合肌瘤蒂部套扎在腹腔镜子宫肌瘤剔除术中的止血效果分析[J].广西医学,2015,37(10):1504-1505,1514.
[17]蒋秋敏.不同方法给予垂体后叶素对子宫肌瘤切除术中循环系统的影响[J].中国煤炭工业医学杂志,2015,18(6):918-920.
[18]努尔买买提江·买合木提,穆哈塔尔·热西提,尚何提,等.不同剂量垂体后叶素对腹腔镜子宫肌瘤剔除术中循环的影响[J].中国肿瘤临床与康复,2013,20(8):841-843.
[19]马建芳,秦嶽,张亚萍.间隔注射垂体后叶素联合套扎止血法在腹腔镜下子宫肌瘤切除术中的应用效果及对循环系统的影响[J].广西医科大学学报,2016,33(4):657-660.