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目的探讨腹腔镜超声在腹腔镜子宫肌瘤剔除术中的应用价值。方法选择2014年12月~2016年2月子宫肌瘤剔除术,肌瘤数目≤5个,肌壁间肌瘤直径≤6 cm,浆膜下肌瘤直径≤10 cm,按术者不同分为腹腔镜超声组(研究组)及腹腔镜组(对照组),最终完成随访研究组86例,对照组96例。2组均行腹腔镜手术,尽可能剔除肌瘤,研究组经腹腔镜超声探查,发现的肌层残留肌瘤尽量剔除。术后3、6、9、12个月行阴道超声检查:术后3个月B超提示子宫肌瘤,定义为子宫肌瘤剔除术后残留;术后3个月B超提示正常,术后6个月或之后B超提示子宫肌瘤,定义为子宫肌瘤剔除术后复发。结果研究组剔除可视及器械可探及的不可视肌瘤后,经腹腔镜超声发现存在残留肌瘤37例(43.0%),共80枚,剔除肌瘤58枚。研究组剔除肌瘤明显多于对照组[中位数4枚vs.2.5枚,Z=-2.413,P=0.016]。研究组残留率和复发率均明显低于对照组[残留率23.3%(20/86)vs.39.6%(38/96),χ~2=5.570,P=0.018;复发率11.6%(10/86)vs.27.1%(26/96),χ~2=6.829,P=0.009]。结论腹腔镜超声应用于腹腔镜下子宫肌瘤剔除术,可有效、安全地减少术后肌瘤残留及复发。
Objective To investigate the value of laparoscopic ultrasonography in laparoscopic myomectomy. Methods From December 2014 to February 2016 myomectomy, the number of fibroids ≤ 5, the diameter of intramural fibroids ≤ 6 cm, the diameter of subserosal fibroids ≤ 10 cm, divided into Laparoscopic ultrasound group (study group) and laparoscopic group (control group), and finally completed 86 cases of follow-up study group and 96 cases of control group. The patients in both groups underwent laparoscopic surgery, and the fibroids were eliminated as much as possible. In the study group, laparoscopic ultrasonography was performed to find out residual muscle myomas in the muscle layer as much as possible. Vaginal ultrasound examination was performed at 3, 6, 9 and 12 months after surgery: B-mode ultrasound was suggested to be uterine fibroids at 3 months after operation, which was defined as residual after myomectomy; B-mode ultrasound was normal at 3 months after operation, 6 months or after B ultrasound prompted hysteromyoma, defined as recurrence of myomectomy. RESULTS: After removing visual and instrumental inoperable myomas, the study group found 37 cases (43.0%) of residual fibroids by laparoscopic ultrasonography, of which 80 had fibroids removed. The study group was significantly more fibroids than the control group [median 4 vs. 2.5, Z = -2.413, P = 0.016]. The residual rate and recurrence rate in the study group were significantly lower than those in the control group (residual rate 23.3% (20/86) vs.39.6% (38/96), χ ~ 2 = 5.570, P = 0.018; the recurrence rate was 11.6% 86) vs.27.1% (26/96), χ ~ 2 = 6.829, P = 0.009]. Conclusion Laparoscopic ultrasound in laparoscopic myomectomy, can effectively and safely reduce the residual fibroids and recurrence.