Clinical Analysis On Treatment Of The Diameter Of Myoma>10cm By Laparoscopic Myomectomy

Objective:To investigate the feasibility and safety of laparoscopic myomectomy in the surgical treatment of the diameter of myoma>10cm.Methods:All the cases from the First Affiliated Hospital of Kunming Medical University and Chenggong Hospital between January 2015 and January 2017 who diagnosed myomas,the whole data were collected and followed up.13 cases ofmyoma larger than 10 cm underwent laparoscopic myomectomy(LM),26 cases of myoma larger than 10 cm abdominal myomectomy(AM)and 26 cases less than 10cm by LM.The operation time,intraoperative blood loss,perioperative hemoglobin loss,postoperative exhaust time,pain,meteorism and the postoperative recurrence were retrospectively analyzed.Results:Compare the maximum diameter of myoma in the operation,the amount of bleeding and operation time of the three groups:the volume of bleeding in group LM<10cm(100.8 + 66.4mL)and operation time(95.6 + 20.8min)were less than the amount of bleeding LM≥10cm(203.8 + 118.0mL)and operation time(130 +18.5min),with considered statistically significant(P<0.05).LM≥10cm group and AM≥10cm group,the intraoperative leiomyoma diameter were(11.8 + 1.7cm)and(11.2 + 2.0cm),there was no statistically significant difference(P>0.05);the amount of bleeding in LM≥10cm group was less than AM≥10cm group(327.9 + 196.0mL),but longer than AM≥10cm group in operation time(96 + 20.3 minutes),the difference was statistically significant(P<0.05).The comparison of the postoperative maximum body temperature,the perioperative hemoglobin decreased,analgesics using,exhaust time,pain,meteorism,drainage,hospitalization time and cost among the three groups:the temperature,analgesics drug using,exhaust time,pain and analgesicsc were,no significant difference(P>0.05)between LM<10cm group and LM ≥ 10cm group;but LM ≥ 10cm group perioperative hemoglobin decrease(25.8±12.2g/L),hospitalization expenses(15108.1±1168.2￥)and drainage(234.6±116.2mL)were more than those in LM<10cm group(P<0.05).Except for costs(12561.3±1814.9￥)of AM≥10cm group less than LM≥10cm group,the other postoperative parameters were all higher than the LM≥10cm group,the differences were statistically significant(P<0.05).The comparison of myoma recurrence and postoperative menstruation:menstrual improvement of LM<10cm group was 16 patients(61.5%),LM≥10cm group was 8(61.5%);and AM≥10cm group was 13(50%),it had no difference(P>0.05).LM<10cm group had no myoma recurrence,2 patients recurred in LM ≥10cm group,and also 2 patients recurred in LM ≥10cm group.In addition to LM≥10cm group had spontaneous abortion,the remaining two groups are currently no pregnancy patients.Conclusions:Laparoscopic surgery in the treatment of intramural uterine fibroids diameter larger than 10cm,which is a relative contraindications compared with traditional open surgery,has the less bleeding,hemoglobin decreased less,faster postoperative recovery and shorter hospitalization time etc.For experienced and skilled surgeons,laparoscopic myomectomy can be performed.