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目的探讨腹腔镜辅助阴式复杂子宫肌瘤剔除术(LAVM)的可行性和手术技巧。方法 2011年2月至2012年5月对收治的数目较多、直径过大、位置特殊的子宫肌瘤患者85例中,采取腹腔镜辅助阴式子宫肌瘤剔除术26例(LAVM组),同期行腹腔镜子宫肌瘤剔除术28例(LM组),行阴式子宫肌瘤剔除术的31例(TVM组),对3组患者的临床资料进行对比分析。结果 LAVM组手术和住院时间显著低于LM组,但高于TVM组,差异均具有统计学意义(P均<0.05),其术中出血量和肛门排气时间低于其他2组(P<0.05),术后发热率显著低于TVM组(P<0.05),但与LM组无明显差异(P>0.05),且术中未见中转开腹病例。术后平均随访时间11个月,LAVM组未见肌瘤复发,LM组复发率为25.0%,TVM组复发率为6.5%,3组间差异有统计学意义(P<0.05);LAVM组月经正常率较高(92.3%),并发症率最低(3.8%),但3组间无明显差异(P>0.05)。结论在严格掌握适应证的情况下,复杂子宫肌瘤可在腹腔镜辅助下经由阴式子宫肌瘤剔除术完成,且具有微创、安全、复发率低等特点,两项技术的结合使用拓宽了复杂子宫肌瘤剔除的手术指征,是一种更为理想的保宫微创手术,但需熟练的操作技术。
Objective To investigate the feasibility and technique of laparoscopic assisted vaginal complex myomectomy (LAVM). Methods From February 2011 to May 2012, 26 patients (LAVM group) with laparoscopic assisted vaginal myomectomy were enrolled in 85 patients with uterine fibroids with large diameter and large diameter. In the same period, 28 cases of laparoscopic myomectomy (LM group) and 31 cases of vaginal myomectomy (TVM group) were performed. The clinical data of three groups were compared. Results The operation and hospital stay in LAVM group were significantly lower than those in LM group, but higher than those in TVM group (all P <0.05). The intraoperative blood loss and anal exhaust time were lower than those in other two groups (P < 0.05). The postoperative fever rate was significantly lower than TVM group (P <0.05), but no significant difference with the LM group (P> 0.05). The average follow-up time was 11 months. No recurrence of myoma was found in LAVM group. The recurrence rate was 25.0% in LM group and 6.5% in TVM group, with significant difference between the three groups (P <0.05) The normal rate was higher (92.3%) and the complication rate was the lowest (3.8%), but there was no significant difference among the three groups (P> 0.05). Conclusion In the strict indications, complex uterine fibroids can be completed by vaginal myomectomy assisted by laparoscopy, and has the characteristics of minimally invasive, safe, low recurrence rate, the combination of the two techniques to broaden The complicated uterine fibroids removal of the surgical indications, is a more ideal minimally invasive palace preservation surgery, but the need for skilled operation techniques.