比较三种不同的止血设备在腹腔镜子宫肌瘤剔除术中的应用。

Comparison of three different hemostatic devices in laparoscopic myomectomy.

机构信息

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Taipei, Taipei, Taiwan, ROC.

Division of Gynecologic Endoscopy, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC.

出版信息

J Chin Med Assoc. 2018 Feb;81(2):178-182. doi: 10.1016/j.jcma.2017.04.012. Epub 2017 Nov 9.

DOI:10.1016/j.jcma.2017.04.012

PMID:29129517

Abstract

BACKGROUND

To compare conventional electrosurgery, LigaSure (Valleylab, Boulder, CO), and Harmonic scalpel (Ethicon Endosurgery, Cincinnati, OH) in terms of perioperative and postoperative outcomes during laparoscopic myomectomy (LM).

METHODS

We retrospectively studied 817 women with symptomatic fibroids who underwent LM between January 1997 and September 2015. Three different instruments were used separately during surgery. The number and weight of removed fibroids, blood loss, operative time, postoperative decrease in the hemoglobin level, and length of hospital stay were measured for statistical analysis.

RESULTS

No significant increase in complications was found in the three groups. Patients in the LigaSure and Harmonic scalpel groups had more numbers of removed fibroids, heavier fibroids removed, and higher rate of pretreatment with GnRH agonist (p < 0.001). These patients also had higher amount of intraoperative bleeding (p = 0.003) and longer operative time (p < 0.001) than those in the conventional electrosurgery group. However, no worse postoperative clinical outcome but shorter length of hospital stay was found in the LigaSure and Harmonic scalpel groups (2.1 ± 0.6, 2.0 ± 0.4 vs 2.5 ± 0.8 days, p < 0.001).

CONCLUSION

The use of all three devices is feasible in LM. LigaSure and Harmonic scalpel can reduce the length of hospital stay without worse surgical outcomes.

摘要

背景

比较传统电外科、LigaSure（Valleylab，Boulder，CO）和 Harmonic 刀（Ethicon Endosurgery，Cincinnati，OH）在腹腔镜子宫肌瘤剔除术（LM）中的围手术期和术后结果。

方法

我们回顾性研究了 1997 年 1 月至 2015 年 9 月期间接受 LM 的 817 例有症状子宫肌瘤患者。手术中分别使用了三种不同的器械。测量切除的肌瘤数量和重量、出血量、手术时间、术后血红蛋白水平下降和住院时间，用于统计分析。

结果

三组患者的并发症无显著增加。LigaSure 和 Harmonic 刀组的患者切除的肌瘤数量更多、切除的肌瘤更重、术前 GnRH 激动剂治疗率更高（p<0.001）。这些患者术中出血量（p=0.003）和手术时间（p<0.001）也高于传统电外科组。然而，LigaSure 和 Harmonic 刀组术后临床结局无恶化但住院时间较短（2.1±0.6、2.0±0.4 与 2.5±0.8 天，p<0.001）。