腹腔镜下子宫肌瘤剔除术中行子宫动脉阻断术对卵巢功能的影响

Effect of Uterine Artery Occlusion during Laparoscopic Myomectomy on Ovarian Function

目的探讨腹腔镜下子宫肌瘤剔除术中行子宫动脉永久阻断术或临时阻断术对卵巢功能及妊娠率的影响。方法将2008年2月～2009年11月120例子宫肌瘤患者采用简单随机化分组方法(随机数字表法以及随机数余数分组法),分为A组(腹腔镜下子宫肌瘤剔除术中行子宫动脉永久阻断术)、B组(腹腔镜下子宫肌瘤剔除术中行子宫动脉临时阻断术)及C组(对照组,单纯行腹腔镜下子宫肌瘤剔除术),各40例,比较3组手术前后血雌二醇(E2)、卵泡刺激素(FSH)、黄体生成素(LH)的变化及术后妊娠率。结果 3组术前、术后激素水平都在卵泡期激素正常范围内。分别比较3组术前、术后3个月、术后6个月及术后12个月的E2、FSH及LH水平,A组术后3个月E2水平较术前下降,FSH升高,差异有显著性(P<0.05),术后6个月及术后12个月与术前比较差异无显著性(P>0.05),A组LH和B、C组各激素不同时点差异无显著性(P>0.05)。3组间比较,A组术后3个月E2水平明显低于B组及C组(P<0.05),其余3组间差异无显著性(P>0.05)。随访2年,3组妊娠率差异无显著性(P>0.05)。结论腹腔镜下子宫肌瘤剔除术中行子宫动脉永久阻断术对卵巢功能的影响是短暂、可逆的,而子宫动脉临时阻断术对卵巢功能几无影响。

Objective To compare the effect of transient and permanent uterine artery occlusion during laparoscopic myomectomy on the postoperative ovarian function and pregnancy rate. Methods From February 2008 to November 2009, 120 patients with symptomatic myomas were randomly divided into three groups with 40 patients in each. Group A underwent laparoscopic myomectomy ＋ permanent uterine artery occlusion, group B received laparoscopic myomeetomy ＋ transient uterine artery occlusion, and group C underwent laparoscopic myomectomy only. We determined the preoperative and postoperative （3, 6, and 12 months after the operation） serum levels of reproductive hormones and the postoperative pregnancy rate of all the patients. And compared the results among the groups. Results In the three groups, the pre- and postoperative levels of reproductive hormones were all in the normal range of the follicular stage. In group A, the level of E2 at 3 months postoperation was significantly decreased, while the level of FSH was significantly increased （both P 〈 O. 05） ; whereas, the results were not significantly different at 6 and 12 months postoperation, compared with the preoperative level （P 〉 0.05） ; no significant changes was detected in the level of LH at all the time points. In groups B and C, we found no significant difference in the level of any reproductive hormones among all time points. Group A showed significantly lower level of E2 than that in the groups B and C at month 3 （ P 〈 0.05） , no other difference was discovered among the three groups. The patients were followed up for two years, during which the pregnancy rate was not significantly different among the groups （P 〉 0.05 ）. Conclusions The effect of permanent uterine artery occlusion during laparoscopic myomectomy on ovarian function is transient and reversible. Transient uterine artery occlusion has little effect on ovarian function.