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目的对比分析经阴道与经腹子宫肌瘤剥除术两种治疗方法的近期疗效以及术中出血量,得出经阴道子宫肌瘤剥除术的临床地位以及影响术中出血量的相关因素。方法选取符合纳入标准的子宫良性肌瘤患者128例,选择经阴道子宫肌瘤剥除术的68例患者为阴式组,选择经腹子宫肌瘤剥除术的60例患者为腹式组,对两组患者的近期疗效及术中出血量进行比较分析。结果阴式组患者术后住院时间、术中出血量、手术时间、术后镇痛使用率、术后肛门排气时间、术后病率分别为(4.7±1.5)d、(74.5±16.6)ml、(61.6±18.5)min、47.24%、(23.7±5.3)h、2.78%,腹式组患者分别为(7.9±1.8)d、(114.8±18.2)ml、(79.5±22.6)min、100.00%、(43.5±6.5)h、2.96%,两组差异均有统计学意义(P<0.05)。通过对影响术中出血量的因素分析发现,多发肌瘤与单发肌瘤患者的出血量差异无统计学意义(P>0.05);肌瘤直径<6 cm患者的术中出血量明显少于肌瘤直径≥6 cm的患者,前、后壁部位肌瘤患者术中出血量明显少于壁间深部肌瘤患者,差异均有统计学意义(P<0.05)。结论经阴道子宫肌瘤剥除术患者在术后住院时间、术后镇痛使用率、手术病率、术中出血量、手术时间以及术后肛门排气时间均明显优于经腹子宫肌瘤剥除术患者,具有无伤口感染征象、术后恢复快、住院时间短、腹壁无瘢痕组织、手术干扰少、手术创伤小等优点,术中出血量取决于子宫肌瘤的直径大小以及生长部位。
Objective To compare and analyze the curative effect of transvaginal and abdominal hysteromyoma stripping surgery and the intraoperative blood loss, to draw the clinical status of transvaginal myomectomy and related factors that influence intraoperative blood loss. Methods A total of 128 patients with benign uterine fibroids who met the inclusion criteria were enrolled. Sixty-eight patients who underwent vaginal uterine fibroids removal were selected as the vaginal group and 60 patients who underwent abdominal uterine fibroids removal were selected as the abdominal group. The two groups of patients with short-term efficacy and blood loss were compared. Results The length of hospital stay, intraoperative blood loss, operation time, postoperative analgesic usage, postoperative anal exhaust time and postoperative morbidity were (4.7 ± 1.5) days and (74.5 ± 16.6) days, respectively, ml, (61.6 ± 18.5) min, 47.24%, (23.7 ± 5.3) h, and 2.78% respectively. The patients in the abdominal group were (7.9 ± 1.8) days and (114.8 ± 18.2) %, (43.5 ± 6.5) h and 2.96%, respectively, with significant difference between the two groups (P <0.05). Through the analysis of the factors influencing intraoperative blood loss, we found there was no significant difference in the amount of hemorrhage among patients with multiple fibroids and single myoma (P> 0.05). The bleeding volume of patients with fibroids less than 6 cm in diameter was significantly less than Patients with fibroids ≥ 6 cm in diameter had significantly less intraoperative bleeding in the anterior and posterior wall fibroids than in those with deep fibroids in the wall (P <0.05). Conclusion The postoperative hospital stay, postoperative analgesic usage, operative rate, intraoperative blood loss, operation time and postoperative anal exhaust time were significantly better in patients with transvaginal uterine fibroids than in those with abdominal uterine fibroids Stripping patients, with no signs of wound infection, postoperative recovery fast, short hospital stay, abdominal scar tissue, less surgical interference, surgical trauma and other advantages, intraoperative bleeding depends on the size of the uterine fibroids and growth sites .