Stringer N H, Walker J C, Meyer P M
Department of Obstetrics and Gynecology, Rush Presbyterian St. Luke's Medical Center, 1725 West Harrison Street, Suite 155, Chicago, IL 60612, USA.
J Am Assoc Gynecol Laparosc. 1997 Aug;4(4):457-64. doi: 10.1016/s1074-3804(05)80039-8.
To compare the results of open myomectomy with those of laparoscopic myomectomy, and to assess complications, surgical results, total hospital cost, and morbidity associated with each procedure.
Retrospective chart review.
Private practice of one surgeon, and Department of Obstetrics and Gynecology, Rush Medical College, Chicago, Illinois.
Ninety-eight women with symptomatic uterine leiomyomata.
Forty-nine consecutive laparoscopic myomectomies were performed between 1993 and 1995, and 49 open myomectomies were performed between 1983 and 1995.
Indications for both procedures were similar, including menometrorrhagia, pelvic pain, and enlarging myomata. Mean operating time for open myomectomies was 133 minutes versus 264 minutes for laparoscopies (p <0.0001). Mean blood loss was 340 ml and 110 ml, respectively (p <0. 001). The greatest blood loss was 1000 ml in the open group and 800 ml in the laparoscopic group. Uterine size at surgery was 12 to 14 weeks in 42.9% of the open group and 9 to 11 weeks in 51% of the laparoscopy group. The open group incurred a total of 272 hospital days versus 29 days in the laparoscopic group (maximum 25 and 3 days, respectively; mean 5.6 and 0.6 days, respectively; p <0.001). The frequency of postoperative complications was higher in the open group (17) than in the laparoscopic group (5, p = 0.0068). Of patients in whom postoperative adhesions were evaluated, the overall frequency of adhesions was lower in the laparoscopic group. Three women in the open group required postoperative transfusions, compared with none in the laparoscopic group. Seven pregnancies have thus far occurred in the laparoscopic group. Three women delivered at term by elective cesarean section, at which no evidence of uterine dehiscence was found. Estimated average cost of each procedure, expressed in April 1995 dollars using the Consumer Price Index, were $14,461 for open myomectomies and $13,814 for laparoscopies (p = 0.65). Linear regression with residual analysis was performed on costs for both groups and revealed significantly increasing time trend for open myomectomies. During the years of this study, the open procedures increased in price at a rate of $868/year. The cost of laparoscopic myomectomies showed no time trend.
Compared with open myomectomy, laparoscopic myomectomy had lower morbidity, no identifiable trend of increasing hospital cost, minimal hospital stay, and fewer complications.
比较开腹子宫肌瘤切除术与腹腔镜子宫肌瘤切除术的结果，并评估每种手术的并发症、手术效果、总住院费用及发病率。
回顾性病历审查。
一位外科医生的私人诊所以及伊利诺伊州芝加哥拉什医学院妇产科。
98例有症状的子宫平滑肌瘤女性。
1993年至1995年连续进行了49例腹腔镜子宫肌瘤切除术，1983年至1995年进行了49例开腹子宫肌瘤切除术。
两种手术的指征相似，包括月经过多、盆腔疼痛和肌瘤增大。开腹子宫肌瘤切除术的平均手术时间为133分钟，而腹腔镜手术为264分钟（p<0.0001）。平均失血量分别为340毫升和110毫升（p<0.001）。开腹组最大失血量为1000毫升，腹腔镜组为800毫升。手术时子宫大小在开腹组42.9%为12至14周，腹腔镜组51%为9至11周。开腹组共住院272天，腹腔镜组为29天（最长分别为25天和3天；平均分别为5.6天和0.6天；p<0.001）。开腹组术后并发症发生率高于腹腔镜组（分别为17例和5例，p = 0.0068）。在评估了术后粘连的患者中，腹腔镜组粘连的总体发生率较低。开腹组有3名女性术后需要输血，而腹腔镜组无。腹腔镜组迄今已有7例妊娠。3名女性通过择期剖宫产足月分娩，术中未发现子宫裂开迹象。按1995年4月使用消费价格指数计算的每种手术估计平均费用，开腹子宫肌瘤切除术为14461美元，腹腔镜手术为13814美元（p = 0.65）。对两组费用进行了带残差分析的线性回归，结果显示开腹子宫肌瘤切除术费用有显著增加的时间趋势。在本研究期间，开腹手术价格以每年868美元的速度上涨。腹腔镜子宫肌瘤切除术费用无时间趋势。
与开腹子宫肌瘤切除术相比，腹腔镜子宫肌瘤切除术发病率更低，无明显的住院费用增加趋势，住院时间最短，并发症更少。
