Minimally Invasive Surgery In The Treatment Of Uterine Fibroids

Objectives：Compare the clinical efficacy and health economics value of laparoscopic,vaginal and laparotomy surgery treatment of uterine fibroids. Explore the clinicalvalue of minimally invasive surgery treatment of uterine fibroids.Methods：3582cases of uterine fibroids which were surgical treated in Jiangxi maternaland child health hospital from December2008to December2012were selected,including2156cases of myomectomy,695cases of subtotal hysterectomy,731casesof total hysterectomy. There could be divided into1060cases of laparoscopicmyomectomy,661cases of laparotomy myomectomy,32cases of vaginalmyomectomy,403cases of hysteroscopic myomectomy,417cases of laparoscopicsubtotal hysterectomy,278cases of laparotomy subtotal hysterectomy,176cases oflaparoscopic total hysterectomy,464cases of laparotomy total hysterectomy,91casesof vaginal total hysterectomy according to the surgical approach. The generalinformation, results of surgery, the incidence of complications, the total costs of itscomponents and other indicators of health economics were comparatively analyzed inthese groups.Results：(1)There was no significantly different of the patients’ general informationamong the different kinds surgical groups (P>0.05).(2)The amount of bleeding, the operative time, the maximum diameter of thefibroids, postoperative hospital time and total hospital time of laparoscopic groupwere less than those of the laparotomy group in the single subserous or intramuraluterine fibroids(P<0.05).The amount of bleeding, the maximum diameter of thefibroids, the number of the fibroids, postoperative hospital time and total hospitaltime of laparoscopic group were less than those of the laparotomy group in multipleuterine fibroids(P<0.05), the operative time of laparoscopic group were longer thanthose of the laparotomy group in multiple uterine fibroids(P<0.05). The maximum diameter of the fibroids and the number of the fibroids in the vaginal group were lessthan those of the laparoscopic and laparotomy group (P<0.05).The amount ofbleeding, the postoperative hospital time, loss of working time and total hospital timein laparoscopic and vaginal group were shorter than those of the laparotomygroup(P<0.05). The success rate of hysteroscopic treatment of the submucous myomawas99.2%, the recurrence rate was5.7%, the pregnant rate was68.4%.The amountof bleeding, operative time, the maximum diameter of the fibroids, the number of thefibroids, anal exhaust time, postoperative hospital time, total hospital time and theloss of working time in hysteroscopic group were significantly less than those of thelaparotomy group(P<0.01).The total incidence of complications in the laparoscopicgroup were less than those of the laparotomy group, the total incidence ofcomplications in the hysteroscopic group were less than those of the laparotomygroup (P<0.05).(3)The amount of bleeding, uterine size, operative time, postoperative hospitaltime, loss of working time and total hospital time of the laparoscopic group were lessthan those of the laparotomy group in subtotal hysterectomy group(P<0.05).Theamount of bleeding and uterine size of the laparoscopic and vaginal group were lessthan those of the laparotomy group in total hysterectomy group(P<0.05).Theoperative time in the laparotomy group and the vaginal group were shorter than thoseof the laparoscopic group(P<0.05). The postoperative hospital time, loss of workingtime and total hospital time in laparoscopic and vaginal group were shorter than thoseof the laparotomy group(P<0.05).The total incidence of complications in thelaparoscopic group were less than those of the vaginal group and laparotomy group(P<0.05).(4)The direct medical costs of the laparoscopic and laparotomy group werehigher than those of the vaginal group in myomectomy group(P<0.05).The directnot-medical costs and the loss of working costs of the laparoscopic and vaginal groupwere lower than those of the laparotomy group in myomectomy group(P<0.05).Thelowest total costs of vaginal group, followed by laparoscopic group were lower thanthe laparotomy group (P<0.05). The direct medical costs, the direct not-medical costs,the loss of working costs and total costs of hysteroscopy group were lower than those of the laparotomy group (P<0.05).(5)The direct not-medical costs, the loss of working costs and the total costs ofthe laparoscopic group were less than those of the laparotomy group in subtotalhysterectomy group(P<0.05).The direct medical costs of laparoscopic group was thehighest, the laparotomy group secondly, which were higher than those of the vaginalgroup in total hysterectomy group (P<0.05).The direct not-medical costs and the lossof working costs in the laparoscopic and vaginal group were significantly lower thanthose of the laparotomy group in total hysterectomy group(P<0.01). The total costs ofthe vaginal group were less than those of the laparoscopic and laparotomy group intotal hysterectomy group (P<0.05).Conclusions：Compared with traditional laparotomy surgery, the laparoscopic and vaginalsurgery have the following advantages, such as: minimally invasive, less bleeding,shorter postoperative hospital stay, quicker recovery, fewer complications, abdominalwall without leaving scars, and less the total costs. However, we should strictly graspvarious surgical indications to avoid excessive minimally invasive in the clinicalprocess of treatment.