機器人輔助與腹腔鏡子宮肌瘤切除術於高複雜度子宮肌瘤患者之比較：一項回溯性世代研究

研究背景：隨著微創手術技術發展，腹腔鏡子宮肌瘤切除術（laparoscopic myomectomy, LM）已成為保留生育功能女性治療子宮肌瘤的重要方式。然而，當患者具有多發性、大型或深層肌瘤時，手術複雜度與術中出血風險顯著增加。近年來，機器人輔助腹腔鏡子宮肌瘤切除術（robotic-assisted laparoscopic myomectomy, RALM）逐漸應用於高複雜度子宮肌瘤手術，但其臨床效益仍有待進一步釐清。研究目的：比較 RALM 與 LM 於高複雜度子宮肌瘤患者之臨床成效，並評估手術方式對圍手術期結果及術後恢復之影響。研究方法：本研究採回溯性世代研究設計，收集 2022 年 1 月至 2025 年 11 月於中山醫學大學附設醫院接受子宮肌瘤切除術之患者資料。納入符合 FIGO 3–6 型肌瘤且具有多發性肌瘤（≥4 顆）或大型肌瘤（最大直徑 ≥8 cm）之高複雜度個案。比較接受 RALM 與 LM 患者之基本特徵、手術時間、術中估計失血量（estimated blood loss, EBL）、血紅素下降值（hemoglobin drop, Hb drop）、術後 24 小時疼痛分數及住院天數。並以多元線性迴歸分析控制潛在干擾因子。研究結果：共納入 183 名患者，其中 LM 組 92 人，RALM 組 91 人。多元線性迴歸分析顯示，RALM 組之手術時間顯著較長（B = 34.926，p < 0.001），但術中估計失血量顯著較少（B = -38.333，p = 0.025）。原始分析顯示 RALM 組之 Hb drop 較高（B = 0.322，p = 0.015），惟逐步敏感性分析顯示，在依序校正術前血紅素、術中輸液量及手術時間後，手術方式與 Hb drop 之關聯逐漸減弱，並不再具有統計顯著性。兩組於術後 24 小時疼痛分數及住院天數方面均無顯著差異。此外，本研究未觀察到轉換開腹手術、術中併發症或術後併發症個案。結論：對於高複雜度子宮肌瘤患者而言，RALM 相較於 LM 雖需較長之手術時間，但可有效降低術中估計失血量。在術後疼痛、住院天數及短期安全性方面，兩種微創手術方式表現相近。研究結果支持 RALM 作為高複雜度子宮肌瘤切除術之安全且可行的手術選擇。

Background: With the advancement of minimally invasive surgical techniques, laparoscopic myomectomy (LM) has become an important treatment option for women with uterine fibroids who wish to preserve fertility. However, surgical complexity and the risk of intraoperative bleeding increase significantly in patients with multiple, large, or deeply located fibroids. In recent years, robotic-assisted laparoscopic myomectomy (RALM) has been increasingly applied in the surgical management of high-complexity uterine fibroids, but its clinical benefits remain to be further clarified.Objective: This study aimed to compare the clinical outcomes of RALM and LM in patients with high-complexity uterine fibroids and to evaluate the effects of surgical approach on perioperative outcomes and postoperative recovery.Methods: This retrospective cohort study collected data from patients who underwent myomectomy at Chung Shan Medical University Hospital between January 2022 and November 2025. Patients with FIGO type 3–6 fibroids and high-complexity uterine fibroids, defined as multiple fibroids (≥4 fibroids) or a largest fibroid diameter ≥8 cm, were included. Baseline characteristics, operative time, estimated blood loss (EBL), hemoglobin drop (Hb drop), postoperative 24-hour pain score, and length of hospital stay were compared between patients who underwent RALM and those who underwent LM. Multivariable linear regression analysis was performed to control for potential confounding factors.Results: A total of 183 patients were included, with 92 patients in the LM group and 91 patients in the RALM group. Multivariable linear regression analysis showed that the RALM group had a significantly longer operative time (B = 34.926, p < 0.001) but significantly lower EBL (B = -38.333, p = 0.025). The initial analysis showed a greater Hb drop in the RALM group (B = 0.322, p = 0.015). However, sequentially adjusted sensitivity analysis demonstrated that after sequential adjustment for preoperative hemoglobin level, intraoperative fluid administration, and operative time, the association between surgical approach and Hb drop was attenuated and became statistically non-significant. No significant differences were observed between the two groups in postoperative 24-hour pain score or length of hospital stay. In addition, no cases of conversion to laparotomy, intraoperative complications, or postoperative complications were observed in this study.Conclusion: In patients with high-complexity uterine fibroids, RALM was associated with a longer operative time compared with LM, but it effectively reduced estimated intraoperative blood loss. Postoperative pain, length of hospital stay, and short-term safety outcomes were comparable between the two minimally invasive surgical approaches. These findings support RALM as a safe and feasible surgical option for high-complexity uterine fibroid myomectomy.