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目的探讨腹腔镜下进行复杂子宫肌瘤剔除术的可行性。方法对67例多发、多部位的子宫肌瘤(即复杂子宫肌瘤)患者在腹腔镜下,使用输尿管红外线显示系统和(或)自制肌瘤分离棒,行子宫肌瘤剔除术,观察手术并发症、手术时间、术中出血量及术后恢复情况。其中多发子宫肌瘤(肌瘤≥5个)者29例,单发子宫肌瘤直径≥7 cm者23例(子宫肌壁间肌瘤19例,子宫浆膜下肌瘤4例),子宫阔韧带肌瘤6例,子宫颈肌瘤9例。剔除子宫肌瘤最多达17个,子宫肌瘤直径≥10 cm者11例,其中直径最大的达15 cm(为阔韧带肌瘤,重2100g)。结果所有病例手术均获成功,无一例中转开腹,无手术并发症发生。平均手术时间(114±32)min,平均术中出血量(114+78)ml,术后平均住院时间5．1d。子宫多发肌瘤、肌壁间肌瘤及宫颈肌瘤术中出血量及手术时间明显多于子宫阔韧带肌瘤及子宫浆膜下肌瘤,差异有统计学意义(P＜0．05)。结论复杂子宫肌瘤剔除术可在腹腔镜下完成,输尿管红外线显示系统的应用,扩大了腹腔镜子宫肌瘤剔除术的手术指征,手术器械的不断创新及熟练的手术技巧是手术成功的关键。
Objective To investigate the feasibility of laparoscopic complex myomectomy. Methods 67 cases of multiple, multi-site uterine fibroids (ie, complicated uterine fibroids) patients under laparoscopy, the use of ureteroscopic display system and / or homemade fibroids separation rods, line myomectomy, observation of surgical complications Disease, operation time, intraoperative blood loss and postoperative recovery. Including multiple uterine fibroids (fibroids ≥ 5) in 29 cases, single uterine fibroids ≥ 7 cm in diameter were 23 cases (19 cases of uterine fibroids, uterine fibroids in 4 cases), uterine wide Ligament fibroids in 6 cases, 9 cases of cervical fibroids. Excluding uterine fibroids up to 17, uterine fibroids ≥ 10 cm in diameter in 11 cases, of which the largest diameter up to 15 cm (broad ligament fibroids, weight 2100g). Results All the cases were successful in operation. None of the cases were converted to laparotomy and no complication occurred. The average operation time (114 ± 32) min, the average blood loss (114 + 78) ml, average postoperative hospital stay 5.1d. Uterine fibroids, intramural fibroids and cervical fibroids bleeding and operative time was significantly more than the uterine fibroids and uterine fibroids, the difference was statistically significant (P <0.05). Conclusions Complex uterine myomectomy can be performed under laparoscopy. The application of the ureter infrared display system expands the indications for laparoscopic myomectomy. The continuous innovation of surgical instruments and skilled surgical techniques are the keys to successful operation .