子宫肌瘤剔除术与子宫切除术对子宫肌瘤患者卵巢功能影响的对照评价

Influence of iaparoscopic hysteromyomectomy and hysterectomy on ovarian function in patients with uterine flbroids

目的 观察并探讨子宫肌瘤剔除术（LSHM）与子宫切除术（TH）对子宫肌瘤（UF）患者卵巢功能的影响.方法 选择接受手术治疗的UF患者96例,采用随机数字表法将患者分为观察组和对照组,各48例.观察组接受LSHM手术;而对照组接受TH手术.测定两组手术前后雌二醇（E2）、AMH、卵泡刺激素（FSH）和黄体生成素（LH）水平,统计两组患者的手术时间、术中失血量、肛门排气时间和平均住院时间及围绝经期症状发生比例.结果 观察组手术时间、术中失血量、肛门排气时间和平均住院时间分别为（65.6±13.2）min、（82.4±6.2）mL、（20.4±4.6）h和（5.2±1.2）d,对照组为（76.5±15.6）min、（118.6±8.9）mL、（34.2±5.4）h和（8.3±1.2）d,两组差异均有统计学意义（t=3.695,P=0.00;t=23.120,P=0.00;t=13.482,P=0.00;t=12.650,P=0.00）;两组术前E2、FSH、LH和AMH水平相比,差异无统计学意义（P〉0.05）;术后,观察组E2、AMH明显高于对照组（t=22.630,P=0.00;t=5.910,P=0.00）,而FSH和LH则明显低于对照组（t=6.853,P=0.00;t=7.024,P=0.00）;观察组围绝经期症状发生率为8.3％（4/48）,对照组为29.2％（14/48）,观察组明显低于对照组（χ^2=6.838,P=0.00）.结论 对UF患者实施LSHM有利于保护患者的卵巢功能,术后恢复更快,值得在临床上进一步推广.

Objective To observe the influence of laparoscopic hysteromyomectomy （ LSHM） and hysterectomy （ TH） on ovarian function in patients with uterine fibroids （ UF） .Methods 96 UF patients with accepted surgery in our hospital were selected .The patients were randomly divided into observation group and control group by random number table method ,48 cases in each group .LSHM was used for surgery in the observation group ,while the control group accepted TH surgery.E2,AMH,FSH and LH levels before and after surgery,the operation time,intraoperative blood loss,flatus time and average length of stay ,as well as proportion of perimenopausal symptoms in the two groups were recorded and compared .Results The operation time ,intraoperative blood loss ,flatus time and average length of stay in the observation group were （65.6 ±13.2）min,（82.4 ±6.2）mL,（20.4 ±4.6）h and （5.2 ±1.2）d,respec-tively,which in the control group were （76.5 ±15.6）min,（118.6 ±8.9）mL,（34.2 ±5.4）h and （8.3 ±1.2）d,the differences were statistically significant （t=3.695,P=0.00;t=23.120,P=0.00;t=13.482,P=0.00;t=12.650, P=0.00）.The differences of E2,FSH,LH and AMH levels before surgery were not statistically significant （all P〉0.05）.After surgery,the E2 and AMH levels were significantly higher in the observation group （t=22.630,P=0.00;t=5.910,P=0.00）,and FSH and LH levels were significantly lower in the observation group （t=6.853,P=0.00;t=7.024,P=0.00）.The incidence rate of perimenopausal symptoms in observation group was 8.3%（4/48）,which in the control group was 29.2% （14/48）,the difference was statistically significant （χ^2 =6.838,P =0.00）. Conclusion LSHM is helpful to protect UF patients＇ovarian function ,with faster postoperative recovery ,and deserves further promotion in clinical practice .