子宫动脉栓塞术对年轻患者卵巢生殖内分泌功能的影响

Impact of uterine artery embolization for fibroids on ovarian function in young woman

目的探讨子宫动脉栓塞术（UAE）治疗子宫肌瘤对年轻患者卵巢生殖内分泌功能的影响。方法将50例年龄≤40岁的子宫肌瘤患者分为两组：〈35岁组（30例）和≥35岁组（20例），实施UAE后完成24—36个月的临床症状、生殖内分泌指标以及妊娠情况的随访。结果两组患者UAE后血清卵泡刺激素（FSH）、黄体生成素（LH）和雌二醇（E2）与术前比较差异均无统计学意义（P〉0．05）；两组患者UAE前后相同时间点血清FSH、LH和E2比较，差异均无统计学意义（P〉0．05）。两组患者月经量、月经期天数在UAE后各时间点均较UAE前减少，差异有统计学意义（P〈0．05）；〈35岁组月经周期在UAE前后比较差异均无统计学意义（P〉0．05），≥35岁组月经周期在UAE后3—6个月与UAE前比较差异有统计学意义，UAE后12个月和24～36个月与UAE前比较差异均无统计学意义（P〉0．05）。〈35岁组中有2例出现继发性闭经；≥35岁组中有3例出现继发性闭经，1例UAE后37个月（42岁时）出现围绝经期综合征症状；血清FSH、LH水平均明显升高。妊娠情况：〈35岁组术后妊娠率和分娩率分别为47％（14／30）和30％（9／30），≥35岁组分别为45％（9／20）和20％（4／20）。结论子宫肌瘤年轻患者行UAE治疗后，有短暂性继发性闭经的现象，未发现卵巢早衰或绝经情况，对卵巢生殖内分泌功能无明显影响。

Objective To evaluate the impact of uterine artery embolization （UAE） for uterine fibroids on ovarian function in young woman. Methods From 50 young patients with symptomatic leiomyomas managed with UAE, completed follow-up 24-36 months of clinical symptomatic, ovarian function continue and pregnancy outcome. All patients participants ranged in age from 24 to 40 years, divided into lower 35 years group （30 cases）and over 35 years group （20 cases）. Results There was no significant difference in serum FSH, LH and E2 levels between two groups before UAE and 3-6, 12, 24-36 months after UAE （P 〉 0.05 ）.The comparison of serum FSH, LH and E2 levels between two groups at the same time points before and after UAE were no significant difference （P 〉 0.05 ）. Menstrual blood loss reduced and duration of flow shorted after UAE in two groups, the differences were significant （P 〈 0.05）. Cycle interval in over 35 years group was longer in 3-6 months after UAE than that before UAE, the difference was significant （P 〈 0.05 ）. There were 2 patients occurred transient secondary amenorrhea after UAE in lower 35 years group, 3 patients occurred in over 35 years group. One patient had menopausal syndrome in 37 months after UAE, and serum FSH and LH levels were found to heighten obviously, 47% pregnancies and 30% deliveries in lower 35 years group, 45% pregnancies and 20% deliveries in over 35 years group. Conclusion Transient secondary amenorrhea would have been occurred in young patients with uterine fibroid performed UAE, no premature ovarian failure and premature menopause.