Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan.
Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan.
PLoS One. 2018 Mar 1;13(3):e0193611. doi: 10.1371/journal.pone.0193611. eCollection 2018.
The purpose of this study was to compare the safety and efficacy of an electrothermal bipolar vessel sealing device (LigaSure™) and traditional electrical cauterization in laparoscopic myomectomy (LM). A total of 756 patients with symptomatic uterine myomas who underwent LM were reviewed retrospectively. A total of 225 cases of LM using LigaSure™ (LML group) were compared with a control group treated with traditional electrical cauterization (LME group) under propensity-matched analysis. Outcome measures for both groups were compared, such as operative time, blood loss (BL), complications, need for blood transfusion, hospital expenses, and hospital stay. Six subgroups were divided according to main myoma size and energy source. No cases required switching to abdominal myomectomy. The number of myomas removed, BL, need for blood transfusion, and complications were not significantly different, whereas hospital stay was longer in the LME group than in the LML group and total hospital expenses were higher in the LML group (p < 0.001). The overall operation duration was significantly longer in the LML group but was not significantly different for main myoma >10 cm (LML vs LME, 121.58 ± 41.77 vs 121.69 ± 44.95, p = 0.99); this likely reflects the operative efficiency on using LigaSure™ to manage large tumors. Significant linear correlations between myoma weight and operative time and BL were seen in both groups. Conventional diathermy is more effective for small-to-medium myomas. Use of the LigaSure™ was efficient for myomas >10 cm.
本研究旨在比较电热双极血管密封装置（LigaSureTM）与传统电凝在腹腔镜子宫肌瘤剔除术（LM）中的安全性和有效性。回顾性分析了 756 例接受 LM 的有症状子宫肌瘤患者。采用倾向性匹配分析，将 225 例采用 LigaSureTM 的 LM（LML 组）与采用传统电凝的对照组（LME 组）进行比较。比较两组的手术时间、出血量（BL）、并发症、输血需求、住院费用和住院时间等。根据主要肌瘤大小和能量源将 6 个亚组进行分组。无一例患者需要转为开腹子宫肌瘤剔除术。LME 组和 LML 组的肌瘤切除数量、BL、输血需求和并发症无显著差异，但 LME 组的住院时间和总住院费用均高于 LML 组（p < 0.001）。LML 组的总手术时间明显较长，但对于>10cm 的主要肌瘤，两者无显著差异（LML 与 LME 相比，121.58±41.77 vs 121.69±44.95，p=0.99），这可能反映了使用 LigaSureTM 处理大型肿瘤的手术效率。两组中，肌瘤重量与手术时间和 BL 均呈显著线性相关。传统电凝对小至中等大小的肌瘤更有效。LigaSureTM 对>10cm 的肌瘤有效。
