腹式巨大子宫肌瘤切除术前预处理临床的探讨.doc

腹式巨大子宫肌瘤切除术前预处理临床的探讨 　　doi：10.3969/j.issn.1007-614x.2014.19.37 　　摘 要 目的：探讨腹式巨大子宫肌瘤切除术的手术技巧。方法：收治子宫肌瘤（子宫12孕周，至少有1个肌瘤直径9 cm）患者129例，行腹式子宫肌瘤切除术，术前2小时阴道后穹隆放置用0.9%氯化钠注射液稀释的米索前列醇600 μg，术中切除肌瘤前先于阔韧带无血管区打洞，安放止血带一根捆扎子宫峡部，暂时阻断子宫动脉上行支。观察手术并发症、手术时间、术中出血量及术后恢复情况。结果：全部手术均顺利完成，均无术后并发症发生，手术时间平均56分钟，术中出血量平均52 ml，平均住院时间5.3天。结论：腹式巨大子宫肌瘤切除术采用预处理是安全有效的，值得临床推广。 　　关键词 子宫肌瘤 米索前列醇 止血带 子宫动脉上行支 　　The clinical study of pre-treatment before operation of abdominal giant uterine myomectomy 　　Wang Zhenghong 　　Gaobei Luhua Hospital of Longmatan District，Luzhou City，Sichuan 646003 　　Abstract Objective：To explore the operation skills of abdominal giant uterine myomectomy.Methods：129 cases with uterine myoma（uterine12 weeks of gestation，at least 1 fibroids diameter9 cm） were selected.They all received abdominal myomectomy.At 2 hours before surgery，we placed 600 μg misoprostol wet by physiological saline in the posterior vaginal fornix.In the operation，we first mode hole in the broad ligament avascular zone before removal of fibroids.We put a tourniquet to strapping uterine isthmus for temporary blocking ascending branch of uterine artery.We observed the operation complications，operation time，amount of bleeding and postoperative recovery operation.Results：All the operation were successfully completed.There was no postoperative complications.The average operation time was 56 minutes.The average blood loss was 52 ml.The average hospitalization time was 5.3 days.Conclusion：In abdominal giant uterine myomectomy，the pre-treatment is safe and effective.It is worthy of clinical application. 　　Key words Myoma of uterus；Misoprostol；Tourniquet；Ascending branches of uterine artery 　　既往症状性子宫肌瘤多采取子宫切除术，但随着晚婚晚育政策的推行，且女性日益重视子宫生理功能及身体的完整性，子宫肌瘤切除术也越来越多[1]。过去子宫肌瘤太大者（子宫12孕周，至少有1个肌瘤直径9 cm）手术难度及风险较大，手术出血多，手术时间长。2007年2月-2014年4月收治子宫肌瘤患者364例，行腹式子宫肌瘤切除术，其中129例巨大子宫肌瘤，术前采用预处理均取得满意疗效。现报告如下。 　　资料与方法 　　2007年2月-2014年4月收治子宫肌瘤患者364例，均有症状且要求保留生育功能，其中129例巨大子宫肌瘤，年龄25～49岁，平均36.9岁。已育87例。所有病例术前均确诊为子宫肌瘤，均为浆膜下或肌壁间肌瘤，B超检查均至少有1个肌瘤直径9