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目的 评估采用腹腔镜辅助下腹壁小切口行肌壁间子宫肌瘤切除术 (LAM)的可行性和安全性。方法 对 37例肌壁间子宫肌瘤患者采用LAM ,肌瘤直径均 >5cm ,<9cm ;其中 2例肌瘤深达宫腔 (肌瘤深入宫腔均 <5 0 % )。选择同期作开腹手术的 35例子宫肌瘤患者作对照组。所有LAM在腹腔镜辅助下完成。一半肌瘤剥离后扩大腹壁正中辅助穿刺点切口至 4～ 5cm长 ,在腹壁切口外完成整个肌瘤剥离术及子宫创面的缝合。临床观察指标包括手术时间 ,术中出血量 ,术中和术后并发症及术后恢复时间 (起床及排气时间 ) ;并与同等条件同期开腹行肌瘤切除术者相比较。结果 LAM组手术所需时间为 10 1min± 5 6min ,与对照组手术所需时间 89min± 38min比较 ,差异无显著意义 ,P>0 .0 5。术中出血量 (中位数 )LAM组为 5 0ml,对照组为 80ml,两者比较 ,P <0 .0 5。LAM组术后病率2 7% (1/ 37) ,对照组为 6 3% (2 2 / 35 ) ,两组比较P <0 0 0 1;术后起床及排气时间LAM组明显早于对照组 ,P <0 .0 0 1。LAM组术中术后无一例出现并发症。 11例不孕症行LAM 1年后有 8例妊娠 ,妊娠进展顺利直至孕 37～ 38周剖宫产。结论 LAM是一种安全可行的技术 ,该技术提供了一种易于操作及损伤最小的切除子宫肌壁间肌瘤之技术 ;它保留了腹腔镜手术的优点 ,
Objective To evaluate the feasibility and safety of laparoscopic assisted small abdominal incision in myometrial myomectomy (LAM). Methods Thirty-seven patients with intramyoctenous uterine fibroids were treated with LAM. The diameter of fibroids was> 5cm and <9cm respectively. Two of them were deep into the uterine cavity (all <50% of uterine fibroids). Select the same period for laparotomy in 35 cases of uterine fibroids as a control group. All LAM is done with laparoscopic assistance. Half of the fibroids after dissection to expand the median abdominal paracentesis incision to 4 ~ 5cm long, complete incision in the abdominal wall fibroids and uterine incision suture. Clinical observation included operation time, intraoperative blood loss, intraoperative and postoperative complications and postoperative recovery time (wake up and exhaust time); and compared with the same conditions open laparotomy myomectomy. Results The time required for surgery in LAM group was 10 1 ± 5 6 min, which was not significantly different from that in control group (89 ± 38 min), P> 0.05. Intraoperative blood loss (median) LAM group was 50ml, the control group was 80ml, the two were compared, P <0. The postoperative morbidity was 27% (1/37) in the LAM group and 63% (22/35) in the control group, P <0 0 01 in both groups; the time to wake up and exhaust in the LAM group was earlier than that in the LAM group Control group, P <0. No complications occurred in the LAM group during operation. Eleven cases of infertility LAM 1 year after 8 cases of pregnancy, pregnancy progressed smoothly until 37 to 38 weeks of pregnancy cesarean section. Conclusions LAM is a safe and feasible technique that provides an easy-to-operate and minimally invasive technique for resecting uterine fibroids; it preserves the advantages of laparoscopic surgery,