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目的比较腹腔镜下子宫肌瘤剔除术(LM)和宫腔镜下子宫肌瘤电切术(TCRM)剔除子宫肌壁间肌瘤(UIM)的优劣及疗效。方法分析2014年2月-2016年3在该院妇科门诊接受诊治的92例UIM患者的临床资料。根据手术方式将其分为LM组(45例)和TCRM组(47例)。比较两组患者的一般资料、手术指征、术后情况、术后妊娠及并发症发生情况。结果两组患者一般资料比较差异无统计学意义(P>0.05)。TCRM组患者的围手术期血红蛋白下降程度明显小于LM组,术中出血量及手术时间均明显少于LM组(P<0.01);TCRM组患者术中输血及转开腹情况少于LM组(P>0.05),术后下床活动时间及肛门排气时间均明显早于LM组(P<0.01),术后住院时间及肌层愈合时间均明显短于LM组(P<0.01),术后镇痛情况明显好于LM组(P<0.01),术后月经改善及肌层愈合情况也好于LM组,但差异无统计学意义(P>0.05),术后复发及发热情况均少于LM组,但差异无统计学意义(P>0.05)。TCRM组患者的术后妊娠情况明显好于LM组,且首次妊娠时间明显短于LM组(P<0.01);TCRM组患者妊娠丢失现象少于LM组,但差异无统计学意义(P>0.05);TCMR组患者的并发症发生率显著低于LM组(P<0.01)。结论 UIM患者行TCRM或LM均较安全可靠,TCRM疗效更佳。
Objective To compare the advantages and disadvantages of laparoscopic myomectomy (LM) and hysteroscopic myomectomy (TCRM) in the treatment of uterine fibroids (UIM). Methods The clinical data of 92 UIM patients who underwent gynecology clinic in our hospital from February 2014 to March 2016 were analyzed. According to the surgical method, they were divided into LM group (45 cases) and TCRM group (47 cases). The general information, operation indication, postoperative condition, postoperative pregnancy and complication of the two groups were compared. Results There was no significant difference in general data between the two groups (P> 0.05). Perioperative hemoglobin in TCRM group was significantly lower than that in LM group, the amount of bleeding during operation and the operation time were significantly less than those in LM group (P <0.01); TCRM group had less blood transfusion and laparotomy than LM group P> 0.05), the time of getting out of bed after operation and the time of expelling anus were significantly earlier than those in LM group (P <0.01), the length of postoperative hospital stay and healing time were significantly shorter than those in LM group (P <0.01) Postoperative analgesia was significantly better than the LM group (P <0.01), postoperative menstrual improvement and muscular healing were also better than the LM group, but the difference was not statistically significant (P> 0.05), postoperative recurrence and fever were less In LM group, the difference was not statistically significant (P> 0.05). The postoperative pregnancy in TCRM group was significantly better than that in LM group, and the time of first pregnancy was significantly shorter than that in LM group (P <0.01). The pregnancy loss in TCRM group was less than that in LM group, but the difference was not statistically significant (P> 0.05 ). The complication rate in TCMR group was significantly lower than that in LM group (P <0.01). Conclusion The TCRM or LM in UIM patients is safer and more reliable, TCRM is more effective.