腹腔镜下子宫肌瘤剔除术联合子宫动脉阻断术对卵巢功能的影响

Evaluation of ovarian function after laparoscopic myomectomy combined with uterine artery occlusion by electrocoagulation

目的观察腹腔镜下子宫肌瘤剔除术联合子宫动脉阻断术术后对卵巢功能和妊娠率的影响。方法回顾分析腹腔镜下子宫肌瘤剔除术163例(对照组)、腹腔镜子宫肌瘤剔除联合子宫动脉阻断术63例(实验组)的临床资料,比较两组术前和术后1～3个月、术后6～12个月血清雌二醇(E2)、卵泡刺激素(FSH)、黄体生成素(LH)水平,观察子宫动脉阻断术后对卵巢功能的影响,同时随访术后妊娠率。结果术后1～3个月性激素水平与自身术前比较,实验组中的A、B两组的FSH水平上升、E2水平下降,差异有统计学意义(P<0.05);对照组激素水平与术前自身水平比较,差异均无统计学意义(P>0.05)。而术后6～12个月各组性激素水平与自身术前比较,差异均无统计学意义(P>0.05)。实验组中的B组有6例(22.22%)发生绝经期症状。对照组妊娠率(26/85)为30.59%,实验组妊娠率(10/33)为30.30%,差异无统计学意义(P>0.05)。结论腹腔镜子宫肌瘤剔除术联合子宫动脉阻断术对卵巢功能有短期的影响,是可逆的,但对妊娠率无明显的影响。

Objective To investigate the ovarian function and pregnancy rate after laparoseopic myemectomy combined with uterine artery occlusion by electroeoagulation. Methods The data of Groups LM-A （ laparoseopie myomectomy, 163 cases） and Groups LM-B （laparoseopie myomeetomy combined with uterine artery occlusion by electrieoagulation ,63 cases） were reviewed retrospectively. Serum E2, FSH and LH level were measured in the two groups pre-operation, 1 -3 months post-operation, and 6 - 12 months post-operation. Ovarian function and pregnancy rate were followed up. Results Compared with pre-operation, serum FSH level increased while E2 level decreased in Group LM-A 1 - 3 months after operation, but not in Groups LM-B. 6 - 12 months after operation, the serum FSH,LH and E2 level were almost the same as pre-operation in both groups. 6 cases in Group LM-B had symptoms of menopause. Pregnancy rate was 30.59% in Groups LM-A and 30.3% in Groups LM-B with no statistical difference （ P 〉 0.05 ）. Conclusions Laparoscopic myomectomy combined with uterine artery occlusion by electrocoagulation impair ovarian function within a short time. But the effect is reversible, and it has no relation with pregnancy rate.