| Objective:To analyze the clinical application,advantages and problems of laparoscopic electric power morcellation during the treatment of uterine leiomyoma.Methods:1)We retrospectively analyzed the clinical datas of 336 patients with uterine leiomyoma(laparoscopy group)who underwent electric power morcellation at the time of myomectomy from January 1st 2014 to December 31 st 2014 and clinical datas of 225 patients(laparotomy group),who underwent trans abdominal myomectomy from January 1st 2011 to December 31 st 2015 at Xinjiang Medical University Affiliated Tumor Hospital of department of gynaecology.we compared the patients age,the sizes and numbers of the uterine leiomyoma,the amounts of blood loss during operation,the operation times,recovery situations after operation,the postoperative recurrence of fibroids,postoperative residual operation fibroids,the hospitalization times after operation between two groups.2)We retrospectively analyzed the clinical datas of patients with uterine sarcoma who underwent electric power morcellation from January 1st 2012 to march 1st 2017 at Xinjiang Medical University Affiliated Tumor Hospital of department of gynaecology and follow up the prognosis;We retrospectively and analyzed clinical data of using electric power morcellation during the past surgery in patients who diagnosed “Leiomyomatosis peritonealis disseminate” when discharged from hospital,from January 1st 2010 to march 1st 2017 at Xinjiang Medical University Affiliated Tumor Hospital of the department of gynaecology and follow up prognosis of them.Results:Compared with abdominal operation group,the laparoscopy group had less bleeding [55.33±31.41 vs 100.05±83.70,t=-8.905,p=0.001],operation times were shorter [80.50±29.81 vs 93.33±36.57,t=-4.556,p=0.017],postoperative hospital stays was shorter[4.93±0.96 vs 6.50±1.66,t=-14.174,p=0.000],and the incidence of postoperative complicationsis were lower [1.49% vs 4.88%,X2=5.625,p=0.018].But postoperative uterine fibroids residual rate was higher [13.88% vs 3.81%,X2=14.405,p=0.037],The diameter of biggest resected fibroids were smaller [6.64±1.73 vs 8.39±3.52,t=-7.80,p=0.000],removed fibroids number were less [2.05±1.88 vs 2.80±2.52,t=-3.99,p=0.000],Submucous myoma and other special site myoma(cervical myoma)were more often chosen by abdominal surgery [P=0.03].In two groups of patients there were no difference(P>0.05)at the aspect of the age [40.30±5.06 vs 39.26±5.80,t=0.873,p=0.097],history of surgery [X2=7.013,P=0.071],[X2=0.656,P=0.720],postoperative pathological type [94.94% vs 93.33%,2.98% vs 4%,1.79% vs2.67%,0.298% vs 0%,X2=1.613,p=0.657],postoperative recurrence rates of uterine leiomyoma [20.41% vs 18.32%,X2=0.356,p=0.551].2)misuse rate of laparoscopic electric power morcellation in uterine sarcoma was 0.377%(6/1591),at a second operation of 3 cases(60%),discovered that the lesions at the peritoneal surface,uterine serosa,pelvic peritoneum,bladder peritoneum and pathologically confirmed that all of them were implantation of uterine sarcoma,caused man-made tumour dissemination and escalation of stages.2 cases died two years after surgery.A total of 6 patients with disseminated leiomyoma were treated in our hospital.And the incidence rate of leiomyomatosis peritonealis disseminata after the laparoscopic myomectomy was 0.082%(2/2452).Conclusion:Application of the electric power morcellation for laparoscopic myomectomy have the advantage of of small trauma,less bleeding,rapid postoperative recovery and short hospitalization time.Chance of crushing uterine sarcoma and causing leiomyomatosis peritonealis disseminataed is very rare,But clinicians should pay attention to the adverse effects of morcellator and take measures to avoid it. |
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