High intensity focused ultrasound combined with laparoscopy in the treatment of uterine myoma of intramural muscle
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摘要:
目的 探讨高强度聚焦超声（HIFU）联合腹腔镜肌瘤剔除术（LM）治疗肌壁间子宫肌瘤的效果。 方法 选取LM治疗肌壁间子宫肌瘤患者30例（腹腔镜组），和HIFU联合LM治疗肌壁间子宫肌瘤患者30例（联合组），对比两组患者在手术时间、术中出血、肛门排气时间、血红蛋白降低值、下床时间、伤口愈合时间、术后病率、住院时间、疼痛强度、月经恢复时间、排卵率、妊娠率、复发率，探究两种治疗方式的临床效果。 结果 联合组在手术时间、术中出血、肛门排气时间、血红蛋白降低值和术后病率显著低于腹腔镜组（P<0.05），下床时间、伤口愈合时间、住院时间、疼痛强度、月经恢复时间、排卵率、妊娠率等在两组间的差异无统计学意义（P>0.05）。 结论 HIFU联合LM治疗肌壁间子宫肌瘤可缩短手术时间、减少术中出血、降低术后病率，值得在临床上提倡。 Abstract:Objective To investigate the effects of high intensity focused ultrasound（HIFU）combined laparoscopic myomectomy (LM) treating uterine myoma of intramural muscle. Methods Thirty cases of uterine myoma of intramural muscle were administrated to LM (laparoscopic group) and 30 cases of uterine myoma of intramural muscle were treated with LM combined with HIFU（combination group）. Operation time, intraoperative bleeding volume, anal exhaust time, decreasing value of hemoglobin, time of off-bed, wound healing time, postoperative complication rate, hospital staying time, intensity of postoperative pain, recovery time of menstruation, ovulation rate, pregnancy rate and recurrence rate were compared. Results Operation time, intraoperative bleeding volume, anal exhaust time, decreasing value of hemoglobin and postoperative complication rate of combined group were significant lower than that of laparoscopic group (P<0.05). There were no statistically difference in time of off-bed, wound healing time, postoperative complication rate, hospital staying time, intensity of postoperative pain, recovery time of menstruation, ovulation rate, pregnancy rate and recurrence rate (P>0.05). Conclusion HIFU jointing LM treating uterine myoma of intramural muscle can shorten operation time, reduce intraoperative bleeding volume and decrease postoperative disease rate. It is worth advocating in clinic. -
表 1 两组患者一般情况比较（n=30，%）
指标 联合组[n(%)] 腹腔镜组[n(%)] χ2 P 年龄（岁） 30~35 26（87.67） 25（83.33） 0.0000 1.0000 36~38 4（12.33） 5（16.67） 文化程度 大专本科 10（33.33） 8（26.67） 0.3175 0.5731 硕士以上 20（66.67） 22（73.33） 家庭人均
年收入（万）<20 4（12.33） 6（20.00） 0.4800 0.4884 ≥20 26（87.67） 24（80.00） 营养状况 一般 8（26.67） 10（33.33） 0.3175 0.5731 良 22（73.33） 20（66.67） 病程（年） <2 8（26.67） 11（33.33） 0.6932 0.4051 ≥2 22（73.33） 19（66.67） 并发症 无 10（33.33） 8（26.67） 0.3175 0.5731 有 20（66.67） 22（73.33） 治疗情况 无 15（50.00） 16（53.33） 0.0667 0.7961 有 15（50.00） 14（46.67） 分娩情况（胎） 0 10（33.33） 12（40.00） 0.2871 0.5921 1 20（66.67） 18（60.00） 
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表 2 两组术中情况比较（
$\, \overline{{x}}{{±}}{{s}}$ ，n=30）分组 手术时间（min） 术中出血量（mL） 联合组 62±8 55±6 腹腔镜组 85±10 82±12 t 9.84 11.02 P 0.00 0.00
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表 3 两组术后情况比较（
$\, \overline{{x}}{{±}}{{s}}$ ，n=30）分组 肛门排气时间（h） 血红蛋白下降（g/L） 下床时间（h） 伤口愈合时间（d） 术后病率（%） 住院时间（d） 疼痛强度（cm） 联合组 12.8±1.2 5.8±1.6 15.2±1.2 4.1±0.5 4.6±0.3 4.7±1.1 1.1±0.9 腹腔镜组 16.4±2.1 10.5±2.4 14.8±1.3 4.2±0.6 20.4±2.8 5.1±1.2 1.2±0.8 t 8.15 8.94 1.24 0.77 30.73 1.35 0.45 P 0.00 0.00 0.11 0.22 0.00 0.09 0.33
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