围绝经期子宫肌瘤患者肌瘤剔除术的价值

The study of myomectomy in patients with uterine leiomyoma in perimenopausal period

目的:探讨围绝经期子宫肌瘤患者的手术方式。方法:选择80例围绝经期子宫肌瘤患者,分为两组,组40例,行子宫肌瘤剔除术;组40例,行子宫全切术。另外同时选择健康女性40例作为对照。手术组分别于术前、术后测血卵泡刺激素(FSH)、雌二醇(E2)并记录有无更年期症状。对照组同期随访2年。结果:术后按要求完成24个月随访共76例,术后3～12个月各组FSH、E2水平与术前相比无差异(P>0.05)。术后24个月组FSH、E2水平与术前相比无差异(P>0.05),组FSH、E2水平与术后3～12个月相比有差异(P<0.05),更年期症状的发生率明显高于组患者同期发病率(P<0.01);对照组完成随访2年,与组FSH、E2水平及更年期症状的发生率相比无差异(P>0.05)。结论:40岁以上的围绝经期子宫肌瘤患者行子宫全切除术后2年卵巢功能发生改变、且可提前出现更年期症状;而行子宫肌瘤剔除术后2年,卵巢功能无改变。为了提高围绝经期子宫肌瘤患者的生活质量,子宫肌瘤剔除术是可取的。

Objective t To study different operation in patients with uterine leiomyoma in perimenopausal period. Methods： 80 patients with uterine leiomyoma in perimenopausal period were randomized into two groups： Group Ⅰ ：40 cases with myomectomy; Group Ⅱ ：40 with total hysterectomy. Another 40 cases healthy age-matched women were chosen as control group. Serum FSH, E2 levels and perimenopausal symptims were detected pre- and post-operation including control group. All cases were followed up for two years. Results：Total of 76 cases were included in this study. There was no difference in levels of Serum FSH, E2 between prior to and 3-12months afer operation in all groups（P〉0.05）. There was no difference in levels of Serum FSH, E2 between prior to and two years afer operation in Group Ⅰ （P 〉0. 05）. There was significant difference in levels of Serum FSH, E2 between 3-12 months and two years afer operation in Group Ⅱ （P〈0. 05）, The prevalence of perimenopausal symptims was higher in Group Ⅱ than Group Ⅰ （P〈0.01）. There was no difference in Serum FSH, E2 levels and perimenopausal symptims between Group I and control group （P〉0.05）. Conclusions zOvarian function can be changed and perimenopausal symptims may appear in patients within two years after total hysterectomy in perimenopausal period over the age of 40 years. Otherwise, no changes of ovarian function can be found with myomectomy. In order to improve living condtions in patients with leiomyoma, myomectomy may be effective.