腹腔镜与宫腔镜子宫肌瘤电切术对子宫壁间肌瘤患者卵巢功能、妊娠情况的影响

Influence of laparoscopic and hysteroscopic transcervical resection of myoma on ovarian function and pregnancy outcomes in patients with intramural uterine fibroids

目的:探讨腹腔镜下子宫肌瘤剔除术(LM)和宫腔镜下子宫肌瘤电切术(TCRM)的治疗效果及对患者卵巢功能、妊娠情况的影响。方法:选取2014年6月至2016年6月西北妇女儿童医院收治的108例子宫壁间肌瘤患者,根据手术方式不同分为TCRM组和LM组,每组54例。比较两组手术相关指标、卵巢功能指标、复发率及妊娠结局。结果:TCRM组的手术时间、术中出血量、术后肛门排气时间、住院时间、围术期血红蛋白(Hb)降低值均显著低于LM组(均P<0.05)。术后3个、6个月,两组雌二醇(E_2)、卵泡刺激素(FSH)、黄体生成素(LH)水平及窦卵泡数(AFC)比较,差异均无统计学意义(均P>0.05),术后6个月两组E_2、FSH、LH均基本恢复至术前水平。TCRM组肌层愈合率显著高于LM组(P<0.05)。两组复发率、妊娠率比较,差异无统计学意义(P>0.05),但TCRM组术后首次妊娠时间较LM组明显缩短(P<0.05)。结论:TCRM与LM对子宫壁间肌瘤患者的卵巢功能均无明显影响,但TCRM治疗的患者术中出血量更少,术后恢复更快,首次妊娠时间更短。

Objective： To investigate the influence of laparoscopic and hysteroscopic transcervical resection of myoma（TCRM） on ovarian function and pregnancy outcomes in patients with intramural uterine fibroids. Methods： 108 patients with intramural uterine fibroids treated in our hospital from June 2014 to June 2016 were selected and divided into TCRM group and laparoseopic myomectomy（LM）group according to different surgical methods （54 cases per group）. The surgical-related indicators, ovarian function, recurrence rate and pregnancy outcomes between the two groups were compared. Results： The operation time, intraoperative blood-loss volume, postoperative anal exhaust time, hospital days and reduction level of Hb in TCRM group were significantly lower than those in LM group （P〈 0. 05 ）. At 3rd, 6th month after surgery, no significant differences were noted in the levels of estradiol （E2）, follicle-stimu- lating hormone （ FSH）, luteinizing hormone （LH） and antral follicle count （AFC） between the two groups （P〉 0. 05）. At 6th month after surgery, the levels of E2, FSH and LH were nearly recovered to the preoperative levels. The muscular healing rate in TCRM group was higher than that in LM group（P〈0. 05）. There was no significant difference in the recurrence rate and pregnancy rate between the two groups （P〉0. 05）, but the first pregnancy time after surgery in TCRM group was significantly shorter than that in LM group （P〈 0. 05 ）. Conclusion： TCRM and LM had no obvious impact on ovarian function in patients with intramural uterine fibroids. TCRM could reduce intraoperative blood loss, promote recovery and shorter the fist pregnancy time.