保留子宫动脉上行支子宫楔形切除术在临床的应用

Application of new cuneiform operation to preserve the ascending uterine arteries

目的探讨应用保留子宫动脉上行支子宫楔形切除术治疗子宫良性病变的有效性和安全性。方法对30例子宫良性病变需子宫切除者进行保留子宫动脉上行支的子宫楔形切除术,分别测定手术前后血清性激素水平、双侧子宫血流参数及子宫大小(研究组)。选同期行单纯肌瘤挖除术25例(对照组1)、全子宫切除术30例(对照组2),比较三组术中出血量、手术时间、术后病率与对照组有无差异。结果研究组术后月经量明显减少,子宫小于正常,双侧子宫血流速度降低,手术前后血清性激素水平无明显改变,提示子宫肌瘤引起的子宫血流动力学改变有所恢复。此术式对卵巢功能无影响;术中出血量、手术时间、术后病率与对照组无差异。结论保留子宫动脉上行支的子宫楔形切除术是治疗子宫肌瘤等良性病变可供选择的好的保守手术方法。

Objective To investigate the effect and safety of the new cuneiform operation of uterus to preserve the integrity of hypothalamus-pituitary-ovary-uterus axis (HPOU) when treating uterine benign disease. Methods The cuneiform operation of uterus with untouched ascending uterine arteries was performed in 30 patients with uterine benign disease (research group). Serum ovarian hormones were determined by radioimmunoassay pre- and postoperatively. Blood flow imaging of uterine arteries and the size of uterus were collected by color Doppler and ultrasound. The control group 1 recruited 25 patients undergone myomectomy and the control group 2 with 30 undergone hysterectomy in the same period and under similar conditions. The blood loss in operation, the duration of operation and the incidence of postoperative morbidity were compared between the research and control groups. Results Significant reduction in the blood flow after operation was observed in the research group. The uterus was smaller than preoperative ones and the blood flowing to the uterine slowed down. No significant change of the ovarian hormones was obtained postoperatively comparing to preoperative data. No significant difference in blood loss, duration of operation and the postoperative morbidity was found in the three groups. Conclusions The cuneiform operation of uterus with untouched ascending uterine arteries is a good option for uterine benign diseases and does not affect the ovarian functions.