腹腔镜与宫腔镜治疗子宫肌瘤对卵巢功能及性生活质量的影响

Impact of hysteroscopic myomectomy and laparoscopic myomectomy on the ovarian function and sexual function of patients with hysteromyoma

目的:研究宫腔镜子宫肌瘤电切术(transcervical resection of myoma,TCRM)与腹腔镜子宫肌瘤切除术(laparoscopic myomectomy,LM)对子宫肌瘤患者卵巢功能及性功能的影响。方法:选择100例子宫肌瘤患者为研究对象,随机分为腹腔镜组与宫腔镜组,每组50例,其中腹腔镜组行LM,宫腔镜组行TCRM,对比观察两组患者手术情况、术后卵巢功能及性生活质量变化的情况。结果:腹腔镜组手术出血量低于宫腔镜组,术后肛门排气时间、术后下床时间及住院时间均明显长于宫腔镜组,差异有统计学意义(P<0.01)。术前两组患者卵泡刺激素(follicle-stimulating hormone,FSH)、黄体生成素(luteotropic hormone,LH)、雌二醇(estradiol,E2)、窦卵泡计数(antral follicle count,AFC)差异均无统计学意义(P>0.05),两组术后3个月E2水平明显下降,FSH、LH水平明显上升,与术后6个月、术前相比差异均有统计学意义(P<0.05);各时间段,两组患者FSH、LH、E2水平与AFC差异均无统计学意义(P>0.05)。术前两组患者性欲望、性唤起、阴道润滑度、性高潮、性生活的满意度及性交疼痛等评分差异均无统计学意义(P>0.05)。术后6个月,两组患者相关指标评分均明显提高,与术前相比差异均有统计学意义(P<0.05)。两组患者间各指标差异均无统计学意义(P>0.05)。结论:TCRM对患者机体损伤相对LM小,两种手术方式均对卵巢功能影响轻微,可有效改善患者的性生活质量。

Objective： To investigate the influence of laparoscopic myomectomy（ LM） and transcervical resection of myoma（ TCRM） on the ovarian function and sexual function of patients with hysteromyoma. Methods： A total of 100 patients that had hysteromyoma admitted were divided into the laparoscopic group（ n = 50） and the hysteroscopic group（ n = 50）. The laparoscopic group was given LM treatment,and the hysteroscopic group was given TCRM treatment. The condition of operation,ovarian function and the sexual function before treatment and in 3rd,6th month after operation were compared between the two groups. Results： The amount of bleeding in the operation in laparoscopic group was less than that in hysteroscopic group（ P 0. 05）,the exhaust time,postoperative ambulation time and hospital stay in laparoscopic group were more than those in hysteroscopic group（ P 0. 01）. There were no significant differences in preoperative follicle-stimulating hormone（ FSH）,luteotropic hormone（ LH）,estradiol（ E2） and antral follicle count（ AFC）between two groups. In 3 months after operation,the levels of E2 in the two groups were significantly decreased,FSH and LH levels were significantly increased,compared with 6 months after operation and preoperative data（ P 0. 05）. The FSH,E2,LH and AFC were not different between the two groups at each time point（ P 0. 05）. There was no significant difference in sexuality,sexual arousal,vaginal lubrication,orgasm,sexual life satisfaction and dyspareunia between two groups preoperatively（ P 0. 05）,in 6 months after surgery,related indicators of two groups significantly improved（ P 0. 05）,the difference was not statistically significant between the two groups（ P 0. 05）. Conclusions： The damage to the body of TCRM is relatively less than LM. The influence of two operations on ovarian function is slight,LM and TCRM can effectively improve the quality of sexual activity.