子宫动脉阻断对腹腔镜下行子宫肌瘤剔除术的临床意义探讨

Clinical study on the role of laparoscopic hysteromyomectomy for uterine artery blockage

目的:探讨腹腔镜下子宫动脉阻断后行子宫肌瘤剔除术对子宫肌瘤患者的临床应用价值及其影响。方法:回顾分析2011年1月至2013年1月我院收治的288例子宫肌瘤患者的临床资料,根据手术方式分为观察组和对照组,其中观察组在腹腔镜下子宫动脉阻断后行子宫肌瘤剔除术,对照组仅行腹腔镜下子宫肌瘤剔除术。对比两组在术前肌瘤最大径≤9cm、>9cm以及总体分析时术中情况、术后卵巢功能恢复、预后、妊娠等方面的差异。结果:观察组手术时间、术中出血量及住院时间均少于对照组,而术前肌瘤最大径≤9cm患者手术中,对照组手术时间少于观察组(P<0.05);观察组FSH、LH及E2均低于对照组(P<0.05);与对照组相比,观察组月经异常症状缓解明显、肌瘤复发率降低、发生闭经较少及子宫体积缩小明显(P<0.05),而术前肌瘤最大径≤9cm患者手术中,两组术后2个月月经异常症状缓解无统计学差异(P>0.05);随访2年,两组妊娠情况比较无统计学差异(P>0.05)。结论:腹腔镜下子宫动脉阻断后行子宫肌瘤剔除术能有效减少术中出血、减小手术创伤、降低子宫肌瘤复发率,对内分泌及妊娠无明显影响,值得临床推广。

Objectives： To investigate the effect of laparoscopic hysteromyomectomy for uterine artery blockage. Methods： The clinical data of 288 cases of hysteromyoma from 2011 to 2013 were analyzed retrospectively.They were divided into experimental group（ laparoscopic hysteromyomectomy with uterine artery blockage） and control group（ laparoscopic hysteromyomectomy without uterine artery blockage）. The condition during operation,postoperative recovery of ovarian function,prognosis,and the probability of pregnancy of two groups were compared.Results： Comparing with the control group,the operation time,blood loss and hospital stay length of experimental group were reduced,but the operation time extended in the maximum diameter ≤9cm uterine fibroids surgery（ P〈0. 05）. FSH,LH and E2 of experimental group were lower than the control group（ P〈0. 05）. Menstrual abnormalities of experimental group were relieved; fibroid recurrence rate was reduced; amenorrhea was more and uterine volume was reduced（ P〈0. 05）,while the difference in menstrual abnormalities was not significant in the maximum diameter ≤9cm uterine fibroids surgery（ P〉0. 05）. Pregnancy between the two groups was of no significant difference by 2- year follow- up（ P〉0. 05）. Conclusion： Laparoscopic hysteromyomectomy for uterine artery blockage is effective in decreasing intraoperative blood loss,operative trauma and recurrence rate without significant effect on endocrine and pregnancy,which deserves clinical expansion.