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目的为要求微创保留子宫的年轻及不育患者,寻找一种子宫肌瘤剔除术的好方法,进一步研究LM术(laparoscopic myomectomy,LM)的优越性。方法将催产素20U,用8号心内注射穿刺针经耻骨联合上2cm正中进针,穿透腹壁后,刺入肌瘤四周肌层先回抽无血再注入,在子宫表面最隆起部位,单极电凝钩纵行切开,长度约为肌瘤直径的2/3,切口深达肌瘤;用肌瘤钻或大抓钳钳夹肌瘤牵拉固定,用拨棒沿假包膜钝性分离子宫肌层,至肌瘤完整剔出(肌瘤较大者,不需剪除过多的浆膜);子宫切口用1-0号可吸收线(微乔线)连续垂直褥式内翻缝合,较大肌瘤,腹腔镜组放置子宫切除器将肌瘤切成长条后取出。结果腹腔镜组与开腹组出血量差异无显著意义,排气时间、离床活动时间及术后住院时间差异有显著意义。结论 LM术是肌壁间及浆膜下子宫肌瘤年轻不育患者理想的手术方式。
The purpose of this study is to find a good method of myomectomy for the treatment of young and infertile patients with minimally invasive retention of the uterus and to further investigate the superiority of laparoscopic myomectomy (LM). Methods The oxytocin 20U was injected through the symphysis pubic syringes with 2 cm median needle through an intracardiac injection needle No. 8. After penetrating the abdominal wall, Unipolar coagulation hook longitudinally incision, the length of about 2/3 of myoma diameter, incision deep fibroids; with myoma drill or pincer clamp clamp leiomyoma traction fixed with a stick along the pseudocapsule Blunt dissection of the myometrium, to myoma completely removed (fibroids greater, without cutting too much serosa); uterine incision with 1-0 absorbable line (micro-line) continuous vertical mattress Turn the suture, the larger fibroids, laparoscopic group placed hysterectomy will be cut into long strips of fibroids. Results There was no significant difference in bleeding volume between laparoscopic group and laparotomy group. There was significant difference in bleeding time, time of leaving bed and postoperative hospital stay. Conclusion LM is an ideal surgical method for young infertile patients with myometrial and subserosal uterine fibroids.