Comparison Of Clinical Effects Of Laparoscopic Myomectomy And Transabdomirml Myomectomy

Objective:To analyze the general situation,perioperative characteristics,residual rate,5-year cumulative recurrence rate,symptom improvement and pregnancy outcome of laparoscopic myomectomy(LM)and transabdomirml myomectomy(TAM)in the treatment of uterine leiomyoma,to compare the clinical efficacy of TAM and LM in the treatment of uterine leiomyoma,and to explore the safety and superiority of laparoscopic myomectomy,so as to provide a basis for clinical selection of reasonable surgical treatment.Method: The clinical data of patients who underwent laparoscopic myomectomy or open myomectomy in the fourth Hospital of Hebei Medical University from January 2013 to December 2014 were collected retrospectively.355 patients were selected according to the inclusion and exclusion criteria.The general condition,perioperative characteristics,hysteromyoma residual rate,5-year cumulative recurrence rate,symptom improvement and pregnancy outcome of the two groups were used as observation indexes,and the data were statistically analyzed by SPSS 22.0 software.Results:There was no significant difference in age,history of pelvicoperation and proportion of discomfort symptoms before operation between LM group and TAM group(P>0.05);The maximum diameter of uterine leiomyoma removed during operation in LM group was smaller than that in TAM group,and the maximum diameter in LM group was 15 cm,the maximum diameter of uterine leiomyoma in TAM group was 25 cm,there was significant difference between the two groups(P<0.05);The proportion of single myoma and multiple myoma in LM group was 54.4% and 45.6%,respectively,the proportion of single myoma and multiple myoma in LM group was significantly lower than that in TAM group,and there was significant difference between the two groups(P<0.05);The residual rates in LM group and TAM group were 12.6% and 8.0%,respectively,for those with more than 4 myomas removed,the residual rates were 8.3%(2/15)and 0%(0/9),respectively,but there was no significant difference between the two groups(both P>0.05);The operation time in LM group was shorter than that in TAM group,and the amount of intraoperative blood loss in LM group was less than that in TAM group(both P<0.05);The placement rate of pelvic drainage tube in LM group and TAM group was 11.2% and 17.6% respectively,and there was no significant difference between the two groups(P>0.05);For the patients with more than 4 myomas removed,there was no significant difference in operation time,intraoperative blood loss and pelvic drainage tube placement rate between LM group and TAM group(all P>0.05);The incidence of complications in LM group and TAM group was 5.6% and 7.1%,respectively,for those with more than 4 myomas removed,the incidence of complications in LM group and TAM group was 7.4%(2/27)and 10.0%(4/40),respectively,there was no significant difference between the two groups(both P>0.05);The postoperative anal exhaust time in LM group was earlier than that in TAM group,and the postoperative hospital stay in LM group was shorter than that in TAM group(both P<0.05);In the LM group,the complete improvement rate of postoperative symptoms was 91.8%,the success rate of pregnancy was 73.3%,and the 5-year cumulative recurrence rate was 30.5%,in TAM group,the complete improvement rate of postoperative symptoms was 97.1%,the success rate of pregnancy was 62.5%,and the cumulative recurrence rate of 5 years after operation was 34.1%,there was no significant difference in 5-year cumulative recurrence rate,symptom complete improvement rate and pregnancy success rate between the two groups(all P>0.05);For the patients with more than 4 myomas removed,the 5-year cumulative recurrence rates of LM group and TAM group were 58.3%(7/12)and 44.4%(4/9),respectively,and there was no significant difference between the two groups(P>0.05).There was no scar uterine rupture during pregnancy in both groups.Conclusions:1.Both transabdomirml myomectomy and laparoscopic myomectomy are safe and effective in the treatment of uterine leiomyoma.2.Laparoscopic myomectomy in the treatment of uterine leiomyoma has the advantages of less interference to the abdominal cavity,quick recovery and beautiful incision.3.The indication of laparoscopic myomectomy in the treatment of uterine leiomyoma can be relaxed appropriately.4.Laparoscopic myomectomy can not completely replace transabdomirml myomectomy.Transabdomirml myomectomy has a wide range of indications and has the advantages of larger diameter and more number of myomas that can be removed.5.The number of leiomyomas may be a risk factor affecting clinical efficacy,and further clinical trials can be designed for study.