王玉玲

[摘要] 目的 探讨边剥离边缝合法在子宫阔韧带肌瘤剥除中的临床应用价值。 方法 回顾性分析手术开腹切除阔韧带肌瘤的90例患者，分为边剥边缝法组51例，先剥离肌瘤再止血组39例，对兩组患者的手术时间、术中出血量、术中术后病发症发生率、术后住院天数进行比较。 结果 两组手术时间、术中出血量、术中术后并发症发生率比较，差异有统计学意义（P<0.05），两组术后住院天数差异无统计学意义（P>0.05）。边剥边缝组手术时间、术中出血量、术中术后并发症发生率较低。 结论 边剥离边缝合法在开腹行子宫阔韧带肌瘤剥除术具有术中出血少、损伤小、手术时间短等优点，是一种安全有效的术式，可临床推广。

[关键词] 边剥边缝法；子宫阔韧带肌瘤；肌瘤挖除；开腹手术；安全性

[中图分类号] R737.33 [文献标识码] B [文章编号] 1673-9701（2017）28-0075-03

[Abstract] Objective To explore the clinical application value of dissection along with suturing method in the removal of uterine broad ligament hysteromyoma. Methods A total of 90 patients with broad ligamentous myoma who were given open dissection were retrospectively analyzed. The patients were divided into two groups： 51 patients in dissection along with suturing method group， and 39 patients in dissection of myoma before hemostasis group. The operation time， intraoperative blood loss， intraoperative and postoperative morbidity rate and postoperative length of hospital stay were compared between the two groups. Results The operation time， intraoperative blood loss， intraoperative and postoperative complications were statistically significant between the two groups （P<0.05）. There was no statistically significant difference in the length of hospital stay after the surgery between the two groups （P>0.05）. The operation time， intraoperative blood loss， and intraoperative and postoperative complications were shorter or less in the dissection along with suturing method group. Conclusion The dissection along with suturing method in the process of uterine broad ligament open hysteromyoma has the advantages of less intraoperative bleeding， less injury and shorter operation time， which is a safe and effective procedure and can be clinically promoted.

[Key words] Dissection along with suturing method； Uterine broad ligament hysteromyoma； Myomectomy； Laparotomy； Safety

子宫肌瘤是女性生殖器最常见的良性肿瘤，由平滑肌及结缔组织组成，常见于30～50岁的妇女子宫[1]。若肌瘤位于宫体侧壁向宫旁生长突出于阔韧带两叶之间称阔韧带肌瘤[2-3]。阔韧带肌瘤是一种特殊类型的肌瘤，阔韧带内有丰富的血管、淋巴、神经及大量疏松组织，且子宫动脉及输尿管均穿过阔韧带基底部，盆腔髂血管亦位于阔韧带延伸的侧盆壁腹膜中，这些特殊的组织解剖结构使阔韧带肌瘤在剥除操作过程中难度较大，易损伤子宫血管、髂血管和输尿管，导致大出血、盆腔血肿、输尿管被结扎或输尿管瘘等[4]。如何避免术中大出血及输尿管损伤是妇科医生关注的问题，现我们回顾性分析近年我院收治的90例开腹子宫阔韧带肌瘤剥除患者的临床资料，探讨边剥离肌瘤边连续缝合包膜的方法的可行性和优势，现报道如下。……