Odejinmi F, Maclaran Kate, Agarwal Nilesh
Whipps Cross University Hospital, Barts Health NHS Trust, Whipps Cross Road, Leytonstone, London, E11 1NR, UK,
Arch Gynecol Obstet. 2015 Mar;291(3):579-84. doi: 10.1007/s00404-014-3434-y. Epub 2014 Sep 13.
To compare peri-operative outcomes between laparoscopic myomectomy (LM) and laparoscopic hysterectomy (LH) for the treatment of uterine fibroids.
Retrospective cohort study including 400 women who underwent LH or LM for the management of uterine fibroids.
LH patients were older, with higher BMI and larger uterine size but LH was associated with shorter operative duration (80.2 vs. 115.7 min, p < 0.0001), lower blood loss (215 vs. 316 ml, p < 0.0001), and shorter hospital stay (1.81 vs. 2.12 days, p = 0.0003). Seven LM patients (3.2%) had blood loss >1000 ml compared with no LH patients and five LM patients (2.3%) required blood transfusion compared to 1 (0.5%) LH patient. Three LM patients (1.9%) and no LH patients required conversion to laparotomy. Bladder injury occurred in three LH cases (1.6%) and no LM cases. When the data was restricted only to women aged 44 years or over, LH was again associated with significantly lower operative duration and estimated blood loss.
Particularly in perimenopausal women, the decision to perform myomectomy can be controversial. These data suggest that there are potential advantages to LH over LM, including reduced operation length, blood loss and hospital stay but increased risk of urinary tract injury.
比较腹腔镜子宫肌瘤切除术（LM）和腹腔镜子宫切除术（LH）治疗子宫肌瘤的围手术期结局。
回顾性队列研究，纳入400例因子宫肌瘤接受LH或LM治疗的女性。
LH组患者年龄更大，体重指数更高，子宫更大，但LH与手术时间更短（80.2对115.7分钟，p<0.0001）、失血量更低（215对316毫升，p<0.0001）及住院时间更短（1.81对2.12天，p=0.0003）相关。7例LM患者（3.2%）失血量>1000毫升，而LH组无此情况；5例LM患者（2.3%）需要输血，而LH组为1例（0.5%）。3例LM患者（1.9%）需要转为开腹手术，LH组无此情况。3例LH患者（1.6%）发生膀胱损伤，LM组无此情况。当数据仅局限于44岁及以上女性时，LH再次与显著更短的手术时间和估计失血量相关。
尤其是在围绝经期女性中，行子宫肌瘤切除术的决策可能存在争议。这些数据表明，LH相对于LM有潜在优势，包括手术时间缩短、失血量减少和住院时间缩短，但尿路损伤风险增加。
