子宫肌瘤介入治疗后围绝经期症状分析

Analysis of perimenopausal symptoms after interventional therapy of hysteromyoma

目的:探讨介入治疗较腹腔镜子宫肌瘤剥除术术后更年期症状是否存在差异。方法:搜集进行子宫肌瘤治疗且未出现围绝经期综合征女性患者60例,根据病情分别选择不同的治疗方案,30例行子宫动脉栓塞术(介入组),30例行腹腔镜子宫肌瘤剥除术(剥除组)。术后3个月、6个月、1年、1.5年和2年分别检测患者雌二醇(E2)、卵泡刺激素(FSH)及黄体生成素(LH)水平,同时于术前及术后6个月、1年、1.5年和2年记录患者是否出现潮热出汗、感觉异常、焦躁、忧郁、关节疼痛、头晕头痛、疲倦乏力、失眠多梦等围绝经期症状,根据改良Kupperman评分法进一步将症状严重程度分为轻度、中度及重度。结果:两组术前卵巢功能各指标差异无统计学意义,介入组术后绝经期症状各时间点均优于剥除组,其中术后6个月症状发生率为10.0%,明显低于剥除组(33.3%),差异有统计学意义(P<0.05)。卵巢功能各指标各复查时间点变化情况与围绝经期症状较吻合,其中术后6个月与1年的E2、3个月与6个月的FSH及3个月、6个月与1年的LH水平两组差异均存在统计学意义(P<0.05)。结论:子宫肌瘤介入治疗与腹腔镜子宫肌瘤剥除术相比,术后短时间内更少出现围绝经症状。

Objective：Hysteromyoma is commonly seen in gynecology.Laparoscopic stripping and interventional uterine artery embolization（UAE）are two widely used approaches in the treatment of this disorder.This study aimed to explore the differences of postoperative perimenopausal symptoms between the two procedures.Methods：60patients with hysteromyoma and with no perimenopausal symptoms were included in our hospital between October 2013 and October 2015.Two therapy approaches were chosen from according to patient’s medical condition.30 cases underwent uterine artery embolization（embolization group）and the other 30 cases underwent laparoscopic stripping of uterine fibroid（stripping group）.Postoperative blood estradiol（E2）,follicle-stimulating hormone（FSH）and progesterone（LH）levels were tested at 3months,6months,1year,1.5years,and 2years,respectively.Symptoms such as facial flushes,sweating,paresthesia,anxiety,depression,joint pain,headache,dizziness,fatigue,insomnia and other perimenopausal symptoms were documented before treatment and at 6months,1year,1.5years,and 2years after treatment.These perimenopausal symptoms were classified as mild,moderate and severe according to modified Kupperman Index.Results：Ovarian function of the two groups before treatment had no significant difference.It was less and lower incidence of perimenopausal symptoms in embolization group than those in stripping group at each follow-up.At 6month follow-up postoperatively,the incidence of symptoms in embolization group was 10%,significantly lower than that in stripping group（33.3%）.E2,FSH,and LH levels at 6month and 1year after treatment between the two groups all had statistically significant differences（P〈0.05）.Conclusion：The uterine artery ablation therapy results in fewer perimenopausal symptoms than the laparoscopic uterine fibroid stripping does in a relative short postoperative period.