| Objective:To observe the efficiency and safety of carbetocin to prevent hemorrhage in laparoscopic myomectomy;to study the impact of different timing of giving carbetocin on the amount of bleeding in laparoscopic myomectomy;to explore the best hysterotonics to stop bleeding and the synergistic regimen of these drugs in laparoscopic myomectomy;.Method:We did a randomized controlled study on 66 patients who were treated with laparoscopic myomectomy in the second hospital of Shanxi Medical University in May 2008～March 2009.Drugs were given before and after the fibroids removed,there are four groups: oxytocin-carbetocin group(18),oxytocin-oxytocin group(15),carbetocin-oxytocin group(17), carbetocin-carbetocin group(16).Patients were assigned into 4 groups randomly.1.Oxytocin-carbetocin group:We added oxytocin 10IU in the pipkin and oxytocin10IU iv drip in 500ml compound sodium chloride injection before myomectomy.And added 100μg carbetocin in the pipkin of 500ml compound sodium chloride injection after myomectomy.2.Oxytocin-oxytocin group:We added oxytocin 10IU in the pipkin and oxytocin 10IU iv drip in 500ml compound sodium chloride injection before myoroectomy.And added oxytocin 10IU in the pipkin and oxytocin 10IU iv drip in 500ml compound sodium chloride injection after myomectomy.3.Carbetocin-oxytocin group:We added carbetocin100μg in the pipkin of 500ml compound sodium chloride injection before myomectomy,And added oxytocin 10IU in the pipkin and oxytocin 10IU iv drip in 500ml compound sodium chloride injection after myomectomy.4.Carbetocin-carbetocin group:We added carbetocin 100μg in the pipkin of 500ml compound sodium chloride injection before myomectomy,and added carbetocin 100μg in the pipkin of 500ml compound sodium chloride injection after myometomy.After the suture of the leiomyoma,misoprostol(600μg) were placed in the rectal for all the patients.We did chemical analysis after admission and at the first and third day after operation using peripheral blood,analysed the factors to be balanced,observed several indexes,including the amount of bleeding,the decrease of hemoglobin,and postoperative morbidity,operating time, discharge time etc.We made a record of the use of extra hysteronics. Results:All the lesions were treated by surgical means successfully,with no convertion to laparotomy and no complication occured.1.The average blood lost during the operation of the 4groups is 177.62±82.98mL,317.50±358.17 mL,159.59±110.47 mLand 280.44±249.84 mL,p> 0.05;the average operating time is 76.77±20.97min,97.88±34.68 min,70.53±27.75 min and 89.28±33.01 min,p> 0.05.2.There are no significant difference among 4 groups in the changes of the blood lost of every stage in the operation and the totle blood lost including during and after the operation.3.The decreasing of hemoglobin at 24 hours and 3 days after operation have no significant difference.4.We monitored the blood pressure and pulse during the operation,there are no significant difference among these groups.5.There are no significant difference among 4 groups in the exhaust time,postoperative complications and average hospitalization time after operation.6.Whether we give carbetocin before or after myomectomy,the blood lost have no significient difference.7.All the intervention measures during or after myomectomy appears in the second group.8.The postoperative pathologic findings are all uterine leiomyoma.Conclusion:Carbetocin,a new drug for the prevention of uterine atony,appears to have a more stable effect on hamostasis.It can strengthen the uterus contraction more effectively when used with oxytocin.Carbetocin not only can reduce the blood lost as oxytocin,but also can be a more reliable drug than it.Patients receiving carbetocin required less intervention.As to the recovery after operation and postoperative complications,there is no significant difference among these groups.Carbetocin is worthy of extending in clinical.
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