The Comparative Study Between Laparoscopic Myomectomy And Transabdominal Myomectomy

Objective:to evaluate the efficacy of laparoscopic myomectomy for feasibility and clinical value,through the comparison of the differences in practice between laparoscopic myomectomy(LM) and transabdominal myomectomy(TAM)Methods:A retrospective analysis of2009January to2011August in Tianjin Harbor Hospital Department of gynecology by laparoscopic or abdominal myomectomy in121cases, they were divided into two groups.61cases of laparoscopic myomectomy not including the3cases who were transferred to laparotomy as the LM group; at the same time,57cases of abdominal myomectomy as the TAM group. We intended to analyze the operation time, bleeding volume, postoperative analgesia drug use rates, postoperative exhaust time, postoperative morbidity, intraoperative and postoperative complication rate, postoperative hospital stay, hospital charges and myoma recurrence rate and myoma residual rate.Results:Two groups in age, body weight, history of pelvic operation, hemoglobin, excluding the number of fibroids are compared, the difference was not statistically significant (P>0.05); LM mean operation time for (100.53±17.97) min, longer than the TAM mean operation time (70.26±12.83) min, the difference was statistically significant (P=0.000); the LM average bleeding volume in operation for the (82.11±53.18) ml, less than that of the TAM mean intraoperative blood loss (113.86±34.68) ml, there was significant differences between two groups (P=0.000); the LM group of postoperative analgesic medication use rate was8.20%, postoperative analgesia after laparotomy group the drug was used in52.63%, the difference were statistically significant differences (P=0.000); the LM group mean postoperative anal exhaust time of (22.19±3.41) h, shorter than the TAM group mean postoperative anal exhaust time (30.18±4.28) h, the difference was statistically significant (P=0.000); the LM group mean postoperative hospital stay for the (4.47±0.87) d, shorter than the TAM group mean postoperative hospital stay (6.39±1.01)d, the difference were statistically significant differences (P=0.000); the average hospitalization expenses for the LM group (11693.95±959.51) yuan, The average cost of hospitalization than TAM group (8409.12±773.99)yuan, the difference was statistically significant (P=0.000); the LM group postoperative morbidity was6.56%, TAM group postoperative morbidity rate was7.02%, no significant differences between the two groups (P=0.975); the LM group postoperative hysteromyoma recurrence rate for22.95%, the TAM group postoperative hysteromyoma recurrence rate was19.30%, there was no significant difference (P=0.625); the LM group in myoma residual rate of4.92%, open group after fibroid residual rate was3.51%, no significant differences between the two groups (P=0.947); LM operation in3cases conversion to open surgery, rate of conversion to open4.69%.Conclusions:Laparoscopic myomectomy with less trauma, less interference to the peritoneal cavity, less bleeding, postoperative exhaust quickly, and lower rate of analgesic medication use, shorter hospitalization time, incision and aesthetic advantages, and not increase postoperative residual rate and recurrence rate of uterine myoma,is an ideal treatment of uterine myoma surgery method and worthy of further promotion, but the operation on the operation of operation skill and operation experience requirements are higher, and the strict operation indications, has certain limitation. Abdominal myomectomy wide indication, it is not restricted by the location, size and number of fibroids, and the hospitalization cost less than laparoscopic operation, suitable for the economic difficulties of the crowd.Laparoscopic myomectomy cannot completely replace the Transabdominal myomectomy. Clinicians should be according to the operation experience and indications to choose proper operation.