探讨对要求保留子宫的宫颈肌瘤患者进行经阴道剔除术与经腹腔镜剔除术的临床疗效。

采集2012年1月至2014年1月在首都医科大学附属北京妇产医院妇科微创中心住院治疗的72例单发宫颈肌瘤患者为研究对象，平均年龄为(35.1±4.6)岁。采用数字表随机法将其分为经阴道组(n=36)与经腹腔镜组(n=36)，两组患者平均年龄分别为(35.6 ±4.5)岁与(34.2 ±4.8)岁；宫颈肌瘤最大直径分别为(5.2±2.4) cm与(4.9±2.6) cm；对其分别采取经阴道宫颈肌瘤剔除术与经腹腔镜宫颈肌瘤剔除术。统计学分析两组患者手术时间、术中出血量及术后最高体温、肛门排气时间、抗菌药物使用天数及住院天数等。本研究遵循的程序符合首都医科大学附属北京妇产医院人体试验委员会所制定的伦理学标准，得到该委员会批准，分组征得受试对象本人的知情同意，并与之签署临床研究知情同意书。两组患者的平均年龄及肌瘤最大直径比较，差异无统计学意义(t=1.552 9，0.508 7；P>0.05)。

两组患者手术过程均顺利，无一例中转开腹，均无邻近器官损伤及术后并发症发生。经腹腔镜组与经阴道组患者手术时间分别为(99.5±45.5) min与(78.4±25.3) min，术中出血量分别为(150.1 ± 88.5) mL与(116.4± 40.5) mL，两组比较，差异均有统计学意义(t=2.431 8，2.077 5；P<0.05)。经腹腔镜组与经阴道组患者的术后最高体温比较，差异无统计学意义(t=0.768 2，P>0.05)；两组术后肛门排气时间分别为(15.3± 5.3) h与(12.9±4.2) h，抗菌药物使用天数分别为(3.4±2.5)d与(2.2±1.2) d，住院天数分别为(5.2± 1.8) d与(4.4±1.2) d，两组比较，差异均有统计学意义(t= 2.129 4，2.596 4，2.218 8；P <0.05)。

经阴道剔除术与经腹腔镜剔除术对治疗宫颈肌瘤均安全可行。二者均具有创伤小、术后恢复快等优点，但经阴道宫颈肌瘤剔除术较经腹腔镜剔除术的手术时间更短、术中出血量更少，而且术后肛门排气时间更短、抗菌药物使用天数和住院天数亦更短，故更具微创意义。

To explore the therapeutic effects of transvaginal cervical myomectomy and laparoscopic cervical myomectomy on patients who required to retain uterus.

A total of 72 inpatients in Center of Minimally Invasive Gynecology, Beijing Obstetrics and Gynecology Hospital from January 2012 to January 2014 with single cervical myoma were enrolled in this study. Their average age was (35.1 ±4.6) years old. The participants were randomly divided into two groups by digital table method, transvaginal cervical myomectomy group (n = 36) whose average age were (35.6 ±4.5) years old,and laparoscopic cervical myomectomy group (n = 36) whose average age were (34.2 ± 4.8) years old. The maximum diameters of cervical myoma in transvaginal cervical myomectomy group and laparoscopic cervical myomectomy group were (5.2 ±2.4) cm and (4.9 ± 2.6) cm, respectively. The indices of observation, such as duration of operation, blood loss volume, maximum body temperature after operation, time of anal exhaust after operation, time of antibiotics use and hospitalization time were analyzed by statisticsal method. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Beijing Obstetrics and Gynecology Hospital. Informed consent was obtained from all participants. There were no significance differences between two groups on average age and maximum diameter of cervical myoma (t= 1.552 9, 0.508 7 ; P>0.05).

The operations were completed successfully in both two groups, without conversion to laparotomy, injury of adjacent organs or postoperative complications. The durations of operation in laparoscopic cervical myomectomy group and transvaginal cervical myomectomy group were (99.5 ± 45.5) min and (78.4 ± 25.3) min, respectively, blood loss volumes were (150.1 ± 88.5) mL and (116.4 ± 40.5) mL, respectively, and both showed significant difference (t = 2.431 8, 2.077 5; P<0.05). The maximum body temperatures after operation in laparoscopic cervical myomectomy group and transvaginal cervical myomectomy group showed no significant difference (t = 0.768 2, P>0.05) . The time of anal exhaust after operation in laparoscopic cervical myomectomy group and transvaginal cervical myomectomy group were (15.3 ± 5.3 ) h and (12.9 ± 4.2) h, respectively, durations of antibiotics treatment were (3.4 ± 2.5) d and (2.2 ± 1.2) d, respectively, hospitalization time were (5.2 ± 1.8) d and (4.4 ± 1.2) d, respectively, and all showed significant differences (t= 2.129 4, 2.596 4, 2.218 8 ; P< 0.05).

Transvaginal cervical myomectomy and laparoscopic cervical myomectomy are both safe and practicable. Patients after operation above have minor wound and rapid recovery from operation. Compared with laparoscopic cervical myomectomy, transvaginal cervical myomectomy have shorter operation time, 1ess blood loss volumes, shorter time of anal exhaust after operation, shorter time of antibiotics treatment and less days of hospitalization, and thus more minimally invasive and worthy of promotion.