腹腔镜下子宫动脉阻断术对女性生育功能的影响研究

Effect of laparoscopic uterine artery occlusion on the fertility function of women

目的探讨腹腔镜下子宫动脉阻断术(LUAO)在子宫肌瘤剔除术中对女性生育功能的影响。方法将126例子宫肌瘤患者随机分为腹腔镜下子宫肌瘤剔除术联合LUAO治疗组(实验组,65例)和单纯腹腔镜下子宫肌瘤剔除术治疗组(对照组,61例)。比较两组患者手术时间、术中出血量,以及手术前后外周血雌二醇(E2)、卵泡刺激素(FSH)、黄体生成素(LH)、子宫动脉阻力系数、子宫动脉搏动系数、卵巢动脉阻力指数、卵巢动脉搏动指数的变化水平及术后月经量、肌瘤复发率、妊娠及生育情况。结果实验组手术时间与对照组比较差异无统计学意义(P>0.05),实验组术中出血量少于对照组(P<0.05)。实验组术后1、3月E2水平较术前下降,FSH水平升高(P<0.05),实验组和对照组术后6、12月各激素水平与术前比较差异无统计学意义(P>0.05)。实验组术后1、3、6、12月子宫动脉阻力指数和子宫动脉搏动指数较术前明显降低(P<0.05),卵巢动脉阻力指数、卵巢动脉搏动指数与术前比较差异无统计学意义(P>0.05)。实验组术后12月月经量较术前明显减少(P<0.05)。实验组术后12月肌瘤复发率低于对照组(P<0.05)。实验组、对照组术后妊娠率、流产率比较差异无统计学意义(P>0.05)。结论腹腔镜下子宫肌瘤剔除术联合LUAO治疗子宫肌瘤可明显减少术中出血,改善月经过多等症状,避免肌瘤复发,对患者卵巢功能和生育功能无明显影响。

Objective To evaluate the effect of laparoscopic uterine artery occlusion（LUAO）on the fertility function of women.Methods A total of 126 patients with hysteromyoma were randomly divided into experiment group,receiving laparoscopic myomectomy（LM）and LAUO,and control group,receiving LM only.Time of operation,intraoperative blood loss,preoperative and postoperative serum levels of reproductive hormones,levels of uterus and ovarian artery blood flow parameters,changes of menorrhea,recurrence of myoma and pregnancy outcomes were compared between the two groups.Results Difference of operative time between the two groups was not significant（P〉0.05）.Intraoperative blood loss of experiment group was less than control group（P〈0.05）.In experiment group,the levels of estradiol（E2）on 1and 3 months after operation were significantly decreased,while the level of follicle-stimulating hormone（FSH）was significantly increased（P〈0.05）.Whereas there were no significant differences of levels of reproductive hormones between those detected on 6,12 months after operation and those detected before operation（P〉0.05）.On 1,3,6and 12 months after operation,resistant index（RI）and pulsatility index（PI）of uterus artery were lower than those detected before operation（P〈0.05）,but the changes of RI and PI of ovarian artery were not significant（P〉0.05）.The menstrual blood volume significantly decreased in experiment group（P〈0.05）.The recurrence rate of myoma in experiment group was obviously lower than control group（P〈0.05）.No significant changes were detected of pregnancy rate and abortion rate between the two groups（P〉0.05）.Conclusion Application of LUAO in the treatment of hysteromyoma could reduce blood loss,improve menorrhea and avoid recurrence of myoma,and be without obvious effects on ovarian function and fertility function of patients.