Comparative study of transabdominal and laparoscopic myomectomy

doi:10.3877/cma.j.issn.1673-5250.2017.01.011

Objective

To explore the residual, recurrence and pregnancy outcomes of uterus myoma (UM) patients with transabdominal and laparoscopic myomectomy.

Methods

From January 2009 to December 2015, a total of 116 cases of UM patients in Department of Obstetrics and Gynecology, Zhongshan Dongsheng Hospital of Guangdong Province were selected as research objects. According to the random number table method, they were divided into the observation group (n=58) and control group (n=58). The patients in observation group were treated with laparoscopic myomectomy, and the patients in control group underwent routine laparotomy myomectomy. The transoperative bleeding volume, operation duration, length of hospitalization, removal number of UM, removal weight of UM, postoperative complications, and postoperative pregnancy outcomes, UM recurrence and residual between two groups were analyzed by statistical methods. There were no significant differences between two groups in the age, diameter and number of UM and constituent ratio of solitary and multiple UM (P>0.05). All the UM patients who agreed to accept this study signed the informed consent.

Results

①Compared with control group, both the transoperative bleeding volume and removal number of UM in the observation group were significantly reduced, and both the operation duration and length of hospitalization were significantly shortened, and removal weight of UM decreased significantly, and all the differences were statistically significant (t=7.136, P=0.029; t=4.913, P=0.041; t=9.259, P=0.017; t=5.715, P=0.035; t=8.149, P=0.023). ②The incidence of postoperative complication in observation group was 15.5% (9/58), which was significantly lower than 27.7% (16/58) in control group, and the difference was statistically significant (χ²=4.132, P=0.045). ③There were no significant differences between two groups in the rates of UM residual, UM recurrence and pregnancy (χ²=0.892, P=0.345; χ²=1.335, P=0.248; χ²=0.637, P=0.425).

Conclusions

Postoperative UM residual, recurrence and pregnancy outcomes of transabdominal and laparoscopic myomectomy are similar. But the operation duration, length of hospitalization and transoperative bleeding volume of laparoscopic myomectomy are superior to transabdominal myomectomy, and leads to less postoperative complications with high safety.

Key words: Leiomyoma, Neoplasm, residual, Neoplasm recurrence, local, Pregnancy outcome, Transabdominal myomectomy, Laparoscopic myomectomy, Women

表1 2组子宫肌瘤患者手术情况比较(±s)

组别	例数	术中出血量(mL)	手术时间(min)	住院时间(d)	剔除的UM个数(个)	剔除的UM重量(g)
观察组	58	163.6±36.4	74.7±9.0	4.9±1.1	3.2±0.9	137.5±72.2
对照组	58	254.9±55.3	97.1±11.2	6.8±1.4	6.8±1.3	314.5±152.1
t值	?	7.136	9.259	5.715	4.913	8.149
P值	?	0.029	0.017	0.035	0.041	0.023

表1 2组子宫肌瘤患者手术情况比较(±s)

组别	例数	术中出血量(mL)	手术时间(min)	住院时间(d)	剔除的UM个数(个)	剔除的UM重量(g)
观察组	58	163.6±36.4	74.7±9.0	4.9±1.1	3.2±0.9	137.5±72.2
对照组	58	254.9±55.3	97.1±11.2	6.8±1.4	6.8±1.3	314.5±152.1
t值	?	7.136	9.259	5.715	4.913	8.149
P值	?	0.029	0.017	0.035	0.041	0.023

表2 2组子宫肌瘤患者术后并发症发生情况比较[例数(%)]

组别	例数	术后出血	切口愈合不良	发热	尿潴留	合计
观察组	58	3(5.2)	0(0)	5(8.6)	1(1.7)	9(15.5)
对照组	58	6(10.3)	3(5.2)	5(8.6)	2(3.4)	16(27.6)
χ²值	?	－	－	－	－	4.132
P值	?	－	－	－	－	0.045

表2 2组子宫肌瘤患者术后并发症发生情况比较[例数(%)]

组别	例数	术后出血	切口愈合不良	发热	尿潴留	合计
观察组	58	3(5.2)	0(0)	5(8.6)	1(1.7)	9(15.5)
对照组	58	6(10.3)	3(5.2)	5(8.6)	2(3.4)	16(27.6)
χ²值	?	－	－	－	－	4.132
P值	?	－	－	－	－	0.045

表3 2组子宫肌瘤患者术后肌瘤残留、复发及妊娠结局比较[例数(%)]

组别	例数	UM残留	UM复发	妊娠
观察组	58	3(5.2)	6(10.3)	36(62.1)
对照组	58	2(3.4)	3(5.2)	33(56.9)
χ²值	?	0.892	1.335	0.637
P值	?	0.345	0.248	0.425

表3 2组子宫肌瘤患者术后肌瘤残留、复发及妊娠结局比较[例数(%)]

组别	例数	UM残留	UM复发	妊娠
观察组	58	3(5.2)	6(10.3)	36(62.1)
对照组	58	2(3.4)	3(5.2)	33(56.9)
χ²值	?	0.892	1.335	0.637
P值	?	0.345	0.248	0.425

[1]	王海波. 263例腹腔镜与开腹手术子宫肌瘤剔除术后效果比较[J]. 中国妇幼保健,2013, 28(11): 1853-1855.
[2]	田玉翠,代荫梅. 子宫肌瘤剔除术后残留和复发的临床危险因素分析[J]. 中华妇产科杂志,2014, 49(8): 594-598.
[3]	张建红,杨宝珍,胡玉玲,等. 腹腔镜下子宫肌瘤剔除术与开腹子宫肌瘤剔除术的对比研究[J]. 医学综述,2013, 19(16): 3066-3068.
[4]	龚敏. 腹腔镜下子宫肌瘤剔除术治疗子宫肌瘤临床疗效观察[J]. 河北医学,2013, 19(5): 690-692.
[5]	裴桂华. 腹腔镜与开腹子宫肌瘤剔除术的比较[J]. 贵阳医学院学报,2015, 40(2): 186-188.
[6]	林建国,何恒君. 腹腔镜与开腹子宫肌瘤剔除术近期临床疗效及组织损伤程度观察[J]. 河北医学,2014, 20(8): 1256-1258.
[7]	蒋春梅. 腹腔镜与开腹子宫肌瘤剔除术后肌瘤残留、复发及妊娠结局的对比分析[J]. 现代诊断与治疗,2015, 26(12): 2788-2789.
[8]	陈咏梅. 腹腔镜子宫肌瘤剔除术与开腹手术治疗后肌瘤残留、复发及妊娠结局的对比研究[J]. 中国现代药物应用,2015, 9(2): 50-51.
[9]	梁炳宏. 腹腔镜与开腹子宫肌瘤剔除术后的对比分析[J]. 中国计划生育和妇产科,2014, 6(9): 69-71.
[10]	徐芳. 腹腔镜与开腹手术治疗子宫肌瘤近期疗效比较[J]. 中华全科医学，2013, 11(7): 1063-1064.
[11]	孙瑞. 腹腔镜子宫肌瘤剔除术与开腹手术治疗后肌瘤残留、复发及妊娠结局的对比研究[J]. 临床医学,2014, 34(4): 81-82.
[12]	杨美芳. 腹腔镜与开腹子宫肌瘤剔除术后肌瘤残留、复发及妊娠结局的对比分析[J]. 中外医疗,2016, 35(7): 68-69, 72.
[13]	支翠芳. 腹腔镜下子宫肌瘤手术的疗效研究[J]. 安徽医药,2014, 18(8): 1538-1540.
[14]	唐靖,蒋蕾. 腹腔镜与开腹手术治疗子宫肌瘤的临床疗效比较[J]. 实用临床医药杂志,2013, 17(19): 82-83, 86.
[15]	王建华. 腹腔镜与开腹手术治疗子宫肌瘤临床对比研究[J]. 中国医药导刊,2013, 15(11): 1808, 1810.
[16]	王金娟,成九梅,金婧,等. 宫颈肌瘤经阴道剔除术与经腹腔镜剔除术的疗效观察[J/CD]. 中华妇幼临床医学杂志(电子版), 2014, 10(6): 779-782.
[17]	崔颖,孟庆伟,申桂华,等. 阴式与腹腔镜下复杂子宫肌瘤剔除术的对比分析[J/CD]. 中华临床医师杂志(电子版), 2011, 5(12): 3608-3610.

[1]	Lu Wang, Yang Fan. Advances in endometrial cancer-related biomarker research[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 511-516.
[2]	Ling Wei, Hui Li, Yi Chen. Current research status on colonization or infection and mother-to-child transmission of extended-spectrum β-lactamase-producing Enterobacteriaceae in pregnant and post-partum women[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 517-521.
[3]	Haoyuan Yang, Jie Gong, Qingwei Zou, Hang Ruan. Current research status on adverse pregnancy outcomes of maternal and infant in pregnant women with asthma[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 522-529.
[4]	Dan Luo, Weimin Kong, Shuning Chen, Xiaoling Zhao, Yunkai Xie. Differences in epithelial mesenchymal transition-related biological markers between in-situ and ectopic endometrial epithelial cells in endometriosis patients[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 530-539.
[5]	Tiantian Chen, Xiaodong Wang, Haiyan Yu. Pregnancy outcome of twin pregnancy with Gitelman syndrome: a case report and literature review[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 559-568.
[6]	Xiaoqing Ju, Yunjie Jin, Xiaoyan Wang. Influencing factors of uterine rupture during vaginal delivery in patients with scarred uterus after cesarean section[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 575-581.
[7]	Juan Gu, Qingqing Sun, Fangfang Hu, Yijuan Cao, Yujuan Qi. Clinical application of endometrial receptivity array to improve pregnancy outcomes in women with repeated embryo implantation failure[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 582-587.
[8]	Beibei Wang, Qixiu Dong, Hongyan Xi, Qingyun Yu, Lijun Zhang, Guang Shi. Analysis of influencing factors of medical abortion failure of pregnant women in early pregnancy and construction of related prediction model and its predictive value for medical abortion success[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 588-594.
[9]	Xu Chen, Yuru Zhan, Chunhua Wang. Clinical value of ABO blood group combined with thyroid function in prediction of gestational diabetes mellitus[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 604-610.
[10]	Mengling Zhou, Zhiwei Xue, Shu Zhou. Changes in size of uterine myoma during pregnancy and its association with adverse pregnancy outcomes[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 611-615.
[11]	Chenxi Ran, Rufei Shen, Mingyu Liao, Qian Liao, Ling Zhou, Yuling Zhang, Min Long. Treatment and management of pituitary tumor during pregnancy[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(04): 487-491.
[12]	Xingchen Liu, Juan Liu, Baobao Wei, Jie Liu, Hui Liu. Correlation analysis of abnormal expression of XIAP and XAF1 with ovarian cancer[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(04): 419-427.
[13]	Yuyan Zhang, Bin Hu, Weihong Zhang, Mei Xu, Hui Zhu, Xinyue Yang, Hailing Liu. Relationship between echocardiography parameters and liver function during the second trimester of pregnancy and their predictive value for adverse pregnancy outcomes[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 499-504.
[14]	Hongqin Gao, Chen Chen, Ruike Lu, Xiaoyu Wang, Min Zhang, Shaohua Li, Lilan Hao, Xincheng Huang, Lingyao Guan, Yunhong Zhang. Impact of vulvovaginal candidiasis on vaginal-cervical microbiota in women[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(06): 720-725.
[15]	Xin Wang, Lin Liu, Zhejia Wen, Chunling Liu, Hong Zhang, Fang Lyu. Effect of stress exposure before pregnancy on subsequent pregnancy outcomes in mice[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(04): 431-437.

Viewed

Full text

Abstract

Please choose a citation manager

Content to export