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目的探讨综合措施减少腹腔镜较大子宫肌瘤切除术中出血的可行性及临床应用价值。方法回顾性分析128例较大子宫肌瘤(12孕周<子宫<16孕周,子宫肌瘤最大直径>9CM)行腹腔镜手术的临床资料,术前三月口服米非司酮缩小肌瘤体积,麻醉后经直肠置入卡前列甲酯栓收缩子宫,术中切除肌瘤前应用止血带捆扎宫颈部位,作为研究组;未采取以上综合措施,单纯行腹腔镜较大子宫肌瘤切除术者128例,作为对照组。观察手术时间、术中出血量及近期疗效。结果研究组均成功行腹腔镜较大子宫肌瘤切除术,无一例中转开腹。对照组因操作困难中转改行开腹瘤体切除术3例,中转腹腔镜全子宫切除4例,开腹全子宫切除1例。研究组无一例术中输血,对照组术中输血8例,两组手术前肌瘤大小、手术时间、术中及术后出血量比较,差异均有统计学意义(P<0.05)。两组患者术后3d平均体温、肛门排气时间、平均拔尿管时间及住院时间比较,差异均无统计学意义(P>0.05)。结论腹腔镜较大子宫肌瘤切除术采用综合措施,可明显减少术中出血,缩短手术时间,安全可行,值得临床推广。
Objective To investigate the feasibility and clinical value of comprehensive measures to reduce bleeding in laparoscopic larger myomectomy. Methods A retrospective analysis of 128 cases of larger uterine fibroids (12 gestational weeks 9CM) laparoscopic surgery clinical data, oral mifepristone in March to reduce fibroids Volume, anesthesia after the rectal card into the forefront of methyl ester suppository contraction of the uterus, intraoperative myomectomy before the application of tourniquet strapping cervical site, as the study group; did not take the above comprehensive measures, simple laparoscopic simple myomectomy 128 cases, as a control group. Observation of operation time, intraoperative blood loss and short-term efficacy. Results The study group were successfully performed laparoscopic hysterectomy, no case of conversion to laparotomy. In the control group, 3 patients underwent open tumor excision, 4 patients underwent laparoscopic total hysterectomy, and 1 patient underwent open hysterectomy because of difficult operation. There was no intraoperative blood transfusion in the study group, 8 cases of intraoperative blood transfusion in the control group. There was significant difference in the size of the fibroids before surgery, the operation time, intraoperative and postoperative bleeding volume between the two groups (P <0.05). There were no significant differences in 3d mean body temperature, anal exhaust time, average catheter removal time and length of hospital stay between the two groups (P> 0.05). Conclusion Larger laparoscopic myomectomy using a comprehensive measure can significantly reduce intraoperative bleeding, shorten the operation time, safe and feasible, worthy of clinical promotion.