腹腔镜下子宫动脉上行支阻断术治疗子宫肌瘤对卵巢功能的影响

Study on the Ovarian Function after Bipolar Coagulation of Ascending Uterine Arteries and Laparoscopic Myomectomy

目的评估腹腔镜下子宫动脉上行支阻断术辅助下行子宫肌瘤剔除术对卵巢功能的影响。方法选取腹腔镜下子宫肌瘤剔除术治疗的124例子宫肌瘤患者,其中63例(A组)行子宫肌瘤剔除前先行子宫动脉上行支阻断,61例(B组)仅行子宫肌瘤剔除术。结果两组随访36~48个月,所有患者均于术后2月内恢复月经来潮,A组第一次月经来潮时间晚于B组(P<0.05)。A组复发率(1.6%)小于B组(13.1%)(P<0.05)。A组术后2月E2水平较术前下降及FSH水平较术前升高,有统计学差异(P<0.05),而术后6月、术后1年及术后2年与术前比较无明显差异(P>0.05)。A组术后2月E2水平低于B组(P<0.05),但术后6月、术后1年及术后2年的E2、FSH和LH水平两组比较无统计学差异(P>0.05)。结论腹腔镜下子宫动脉上行支阻断术辅助下行子宫肌瘤剔除术对卵巢功能短期内可能有影响,但是一般可以恢复。

Objective To evaluate the ovarian function after the bipolar coagulation of ascending uterine arteries combined laparo- scopic myomectomy. Methods 124 cases with uterine leiomyomas underwent laparoscopic myomectomy. 63 cases underwent bipolar coagulation of ascending uterine arteries before myomectomy as reseach group（group A）,the other 61 cases as control group（group B） unerwent myomectomy only. Results All patiens were followed up for 36 to 48 months. All patiens resumed menstruation in two months after operation. The first manstruation time in group A was later than that in group B （P〈0.05）. The rate of recurrence were 1.6% in group A,and 13.1% in group B. There was significant difference in the rate of recurrence （P〈0.05）. Compared with pre-op- eration,serum FSH level increased while E2 level decreased in Group A two months after operation（P〈0.05）. 6-24 months after op- eration,the serum FSH,LH and E2 level were almost the same as pre-operation in both groups （P^0.05）. Group A compared with group B,the serum E2 level was lower in two months after operation （P〈0＇05）,but the serum FSH,LH and E： level were not significant difference 6 -24 months after operation （/：~0.05）. Conclusion Laparoscopie myomeetomy combined with the bipolar coagulation of ascending uterine arteries impair ovarian funetion within a short time,but the effect is reversible.