本文選題：卡孕栓　切入點：腹腔鏡　出處：《青島大學(xué)》2017年碩士論文

【摘要】：子宮肌瘤(uterus myoma),亦稱子宮平滑肌瘤(uterus leiomyoma)。其中,約1/3的患者表現(xiàn)為月經(jīng)過多及盆腔壓迫癥狀需行手術(shù)治療。對于有生育要求的患者腹腔鏡下子宮肌瘤剔除術(shù)(Laparoscopic myomectomy)是首選治療方法。而手術(shù)的安全性及有效性關(guān)鍵在于控制術(shù)中出血。同時,手術(shù)者嫻熟的縫合技巧及與助手高度的配合也可見減少術(shù)中失血量及輸血率,當(dāng)然,結(jié)合其他減少術(shù)中出血的方法效果會更好。本研究詣在為卡孕栓在腹腔鏡下子宮肌瘤剔除術(shù)中的臨床應(yīng)用提供理論依據(jù)。目的:評估卡孕栓在腹腔鏡下子宮肌瘤剔除術(shù)中(Laparoscopic myomectomy)使用的有效性、安全性及可行性。方法:選取2016年1月至2016年6月在青島市婦女兒童醫(yī)院婦科中心因子宮肌瘤選擇行腹腔鏡下子宮肌瘤剔除術(shù)的80名患者為研究對象,將其隨機分為A組(卡孕栓組)40例(多發(fā)性子宮肌瘤22例,單發(fā)性子宮肌瘤18例),全身麻醉成功后陰道后穹窿放置卡孕栓2枚(東北制藥總廠)(1.0mg);B組(垂體后葉素組)40例(多發(fā)性子宮肌瘤23例,單發(fā)性子宮肌瘤17例),術(shù)中在切開子宮漿膜層前于子宮肌瘤瘤體與子宮肌層交界處注射垂體后葉素6IU+0.9%氯化鈉注射液l0ml。兩組患者均在氣管插管全麻下行腹腔鏡下子宮肌瘤剔除術(shù)。比較兩組術(shù)中出血量、手術(shù)時間、術(shù)前/后血紅蛋白差值的改變、收縮壓、舒張壓和心率的變化(包括用藥前、用藥后10min、用藥后30min、術(shù)后3天)以及術(shù)后胃腸道功能恢復(fù)情況。結(jié)果:兩組均順利完成手術(shù),術(shù)中無周圍臟器損傷(膀胱、輸尿管、直腸等損傷),術(shù)中無中轉(zhuǎn)開腹,術(shù)后無大出血。1.兩組患者術(shù)中出血量分別為84.7±63.9ml、87.1±52.6ml,手術(shù)前后血紅蛋白的差值分別為22.3±17.0g/L、19.3±20.6g/L,平均手術(shù)時間是93.3±40.0min、117.3±37.9min,A組術(shù)中出血量、手術(shù)前后血紅蛋白的差值、手術(shù)時間與B組無顯著差異(P均0.05)。2.兩組患者術(shù)后平均排氣時間分別為27.2±2.79h、36.1±4.21h,A組術(shù)后排氣時間明顯短于B組,差異有統(tǒng)計學(xué)意義(t=11.11,P0.05)。3.B組患者用藥后10min的收縮壓、舒張壓及心率明顯升高,用藥后30min血壓和心率恢復(fù)正常,A組術(shù)中對血液動力學(xué)的影響小,明顯優(yōu)于B組(兩組各時間點收縮壓的比較:F=43.0,P0.05;兩組各時間點舒張壓的比較:F=64.2,P0.05;兩組各時間點心率的比較:F=56.2,P0.05)。結(jié)論:1.卡孕栓及垂體后葉素在腹腔鏡下子宮肌瘤剔除術(shù)術(shù)中出血量、手術(shù)前后血紅蛋白差值、手術(shù)時間方面無顯著差異。2.卡孕栓對胃腸功能及血流動力學(xué)影響方面優(yōu)于垂體后葉素。3.在腹腔鏡下子宮肌瘤剔除術(shù)中陰道后穹窿放置卡孕栓操作簡便、安全有效,副作用小,值得在臨床工作中推廣應(yīng)用。
[Abstract]:Uterine leiomyoma, also known as uterine leiomyoma.About a third of the patients had menorrhagia and pelvic compression symptoms that required surgical treatment.Laparoscopic hysteromyomectomy is the first choice of treatment for patients with fertility requirements.The key to the safety and effectiveness of the operation is to control intraoperative bleeding.At the same time, the skillful suture skill and the high cooperation with assistant can also reduce the amount of blood loss and blood transfusion rate, of course, combined with other methods to reduce intraoperative bleeding will be more effective.The purpose of this study is to provide theoretical basis for clinical application of pregnancy card suppository in laparoscopic hysteromyomectomy.Objective: to evaluate the efficacy, safety and feasibility of pregnancy suppository in laparoscopic hysteromyomectomy.Methods: from January 2016 to June 2016, 80 patients who underwent laparoscopic hysteromyomectomy at the gynecological center of Qingdao Women and Children's Hospital were selected as the study objects.They were randomly divided into two groups: group A (40 cases with multiple uterine leiomyoma, 22 cases with multiple uterine leiomyoma).There were 18 cases of single uterine leiomyoma, 2 pregnant suppositories were placed in the posterior fornix of vagina after general anesthesia (group B: 1.0 mg / L) (group B) (40 cases of pituitary fibroin group (23 cases of multiple uterine leiomyoma).17 cases of single uterine leiomyoma were treated with hypophysin 6IU 0.9% sodium chloride injection 10 ml before incision of uterine serous layer at the junction between uterine fibroid tumor and myometrium.Both groups underwent laparoscopic hysteromyomectomy under tracheal intubation and general anesthesia.The changes of blood loss, operation time, hemoglobin difference before and after operation, systolic blood pressure, diastolic blood pressure and heart rate were compared between the two groups (including before, 10 min after medication, 30 min after treatment, 3 days after operation) and the recovery of gastrointestinal function after operation.Results: the operation was successfully completed in both groups. There were no perioperative organ injuries (bladder, ureter, rectum, etc.), no conversion to laparotomy, and no massive bleeding after operation.The mean postoperative exhaust time of the two groups was 27.2 鹵2.79 hours and 36.1 鹵4.21 hours respectively, which was significantly shorter than that in group B, and the difference was statistically significant. The systolic blood pressure, diastolic pressure and heart rate of 10min in group B were significantly higher than those in group B.The effect of 30min blood pressure and heart rate on hemodynamics in group A was less than that in group B (the comparison of systolic blood pressure at each time point in two groups was 43.0% P0.05; the comparison of diastolic blood pressure at different time points in two groups was: FN 64.2% P0.05; the comparison of heart rate between two groups at different time points: F56.2P0.05g).Conclusion 1.There was no significant difference in blood loss, hemoglobin difference before and after operation and operative time between the two groups in laparoscopic hysteromyomectomy.The effect of carbopregnancy suppository on gastrointestinal function and hemodynamics was superior to that of pituitrin. 3.It is simple, safe and effective to place pregnancy embolus in posterior fornix of vagina during laparoscopic hysteromyomectomy, so it is worth popularizing in clinical work.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.33

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