三种不同术式对子宫肌瘤患者卵巢储备功能、妊娠结局的影响比较

Comparison of three different surgical procedures on ovarian reserve function and pregnancy outcomes of patients with uterine fibroids

目的探讨腹腔镜子宫肌瘤剔除术(LM)、子宫动脉栓塞术(UAE)及射频消融术(RA)对子宫肌瘤患者卵巢储备功能、妊娠结局的影响。方法选取2012年7月至2015年7月在北京中医医院顺义医院采用子宫肌瘤剔除术、射频消融术以及子宫动脉栓塞术3种方法治疗的子宫肌瘤患者349例,根据治疗方式分为LM组187例、UAE组76例,RA组86例,比较3种治疗方式的临床疗效、卵巢储备功能以及妊娠结局。结果 RA的手术时间和住院时间最短,同UAE组、LM组比较均有统计学差异(t值分别为9.23、10.13、9.78、10.03,均P<0.05);临床疗效方面,LM治愈率显著高于RA组、UAE组(x^2值分别为6.04、8.31,均P<0.05);术后1个月,LM组FSH、FSH/LH、E_2均明显升高、而AFC显著降低,同RA组、UAE组比较有显著性差异(t值6.76~9.32,均P<0.05);RA组、LM组成功妊娠率显著高于UAE组(x^2值分别为7.33,6.36,均P<0.05),其中RA组顺产率显著高于LM组、UAE组(x^2值分别为10.54、7.73,均P<0.05);不良妊娠中,UAE组早产率、流产率均高于LM组、RA组(x^2值分别为6.13、6.09、587、5.91,均P<0.05)。结论 LM临床治愈率高于RA、UAE,但其术后初期卵巢储备功能略有下降,RA、UAE对卵巢储备功能无明显影响,RA成功妊娠率最高,在临床上值得推广。

Objective To explore the influence of laparoscopic myomectomy （LM）, uterine artery embolization （UAE） and radiofrequency ablation （RA） on ovarian reserve function and pregnancy outcomes of patients with uterine fibroids. Methods From July 2012 to July 2015 patients with uterine fibroids undergoing LM, UAE and RA in Shunyi Hospital of Beijing Chinese Medicine Hospital were divided into LM group, UAE group and RA group according to operation type. Three groups were compared in clinical efficacy, ovarian reserve function and pregnancy outcomes. Results In RA group surgery and hospital stay were shortest, which were statistically different from UAE group and LM group （t value was 9.23, 10.13, 9.78 and 10.03, respectively, all P 〈 0.05）. In terms of clinical efficacy, curative rate of LM group was significantly higher than RA group and UAE group （χ^2 value was 6.04 and 8.31, respectively, both P 〈 0.05 ）. One month after surgery, FSH, FSH/LH and E2 increased obviously but AFC declined remarkably in LM group, and they were significantly different from RA group and UAE group （ t value ranged 6.76 - 9.32, all P 〈 0.05 ）. Compared with UAE group, RA group and LM group had significantly higher successful pregnancy rate （χ^2 value was 7.33 and 6.36, respectively, both P 〈 0.05 ） , but RA group had significantly higher spontaneous abortion rate than LM group and UAE group （χ^2 value was 10.54 and 7.73, respectively, both P 〈0.05）. In adverse pregnancy, preterm birth rate and abortion rate were higher in UAE group than in LM group and RA group （χ^2 value was 6.13, 6.09, 587 and 5.91, respectively, all P 〈 0.05）. Conclusion Clinical curative rate of LM is higher than RA and UAE, but ovarian reserve function falls slightly at the beginning period after surgery. RA and UAE have no significant influence on ovarian reserve function. RA obtains highest successful pregnancy rate and is worthy of promotion in clinical practice.