腹腔镜下子宫动脉阻断术联合肌瘤切除术治疗子宫肌瘤的临床研究

Clinical study on laparoscopic uterine artery occlusion combined with myomectomy in treatment of uterine fibroids

目的比较腹腔镜下子宫动脉阻断术联合肌瘤切除术与单纯肌瘤切除术治疗子宫肌瘤的近远期临床疗效及围术期并发症,寻找子宫肌瘤治疗最佳方案,提升子宫肌瘤患者身体及生育健康水平。方法选择该院2014年6月-2016年6月收治的子宫肌瘤患者60例作为研究对象,将其按照就诊顺序编号,采用数字随机表法分为研究组与对照组,每组30例。研究组采用腹腔镜下子宫动脉阻断术联合肌瘤切除术治疗,对照组直接行子宫肌瘤切除术治疗。比较两组患者术中出血量、手术时间及术后排气时间。比较两组患者术前、术后3个月、术后6个月及术后12个月卵巢功能相关指标:雌二醇(E2)、卵泡刺激素(FSH)及黄体生成素(LH)的变化。比较两组患者术后住院期间及随访期内并发症情况、自然妊娠率、子宫肌瘤复发率。结果研究组患者出血量明显低于对照组(P<0.05),两组手术时间、术后排气时间比较,差异无统计学意义(P>0.05)。两组术后3个月,研究组患者E2低于术前,同时低于对照组,FSH高于术前,同时高于对照组(P<0.05)。两组患者LH术后较术前无明显变化,术后组间差异无统计学意义(P>0.05),术后6个月、12个月两组患者E2、FSH、LH与术前比较,差异无统计学意义,组间比较差异也无统计学意义(P>0.05)。术后1个月内,研究组并发症发生率显著低于对照组(P<0.05),术后随访18个月,研究组自然妊娠率高于对照组,但组间比较差异无统计学意义(P>0.05),研究组子宫肌瘤复发率明显低于对照组(P<0.05)。结论腹腔镜下子宫动脉阻断术联合肌瘤切除术治疗子宫肌瘤患者,可明显降低患者术中出血量、术后并发症发生率及子宫肌瘤复发率,短期内会对卵巢功能有所影响,但此过程可逆,6个月后卵巢功能相关指标均恢复正常。对生育功能无不利影响。

Objective To compare short-term and long-term clinical efficacies,and perioperative complications of laparoscopic uterine artery occlusion combined with myomectomy,simple myomectomy in treatment of uterine fibroids,find the optimal treatment method,improve body and reproductive health level of patients with uterine fibroids. Methods Sixty patients with uterine fibroids treated in Huaibei Maternal and Child Health Care Hospital from June 2014 to June 2016 were selected and divided into study group and control group according to random number table,30 patients in each group. The patients in study group were treated by laparoscopic uterine artery occlusion combined with myomectomy,and the patients in control group were treated by myomectomy. The amounts of blood loss during operation,operation time,and postoperative exhausting time in the two groups were compared,the changes of related indexes of ovarian function before operation,at 3,6,and 12 months after operation in the two groups were compared,including estradiol（ E2）,follicle-stimulating hormone（ FSH）,and luteinizing hormone（ LH）. The incidence rates of complications in hospital and follow-up period were compared between the two groups. Results The amount of blood loss during operation in study group was statistically significantly lower than that in control group（ P〈0. 05）,there was no statistically significant difference in operation time and postoperative exhausting time between the two groups（ P〈0. 05）. At three months after operation,the level of E2 in study group was statistically significantly lower than that before operation and that in control group,respectively,while the level of FSH in study group was statistically significantly higher than that before operation and that in control group（ P〈0. 05）. There was no statistically significant difference in the level of LH after operation between the two groups（ P 0. 05）. After operation,there was no statistically significant difference in the level of LH between the two groups（ P〈0. 05）. In the two groups,there was no statistically significant difference in the levels of E2,FSH,and LH between before operation and at 6 and 12 months after operation,and there was no statistically significant difference between the two groups（ P〈0. 05）. The incidence rate of complications within one month after operation in study group was statistically significantly lower than that in control group（ P〈0. 05）. At 18 months after operation,the spontaneous pregnancy rate in study group was higher than that in control group,but there was no statistically significant difference between the two groups（ P〈0. 05）,the recurrence rate of uterine fibroids in study group was statistically significantly lower than that in control group（ P〈0. 05）. Conclusion Laparoscopic uterine artery occlusion combined with myomectomy can significantly reduce the amount of intraoperative bleeding,the incidence rates of postoperative complications,and recurrence rate of uterine fibroids,which has short-term effect on ovarian function,but the process is reversible,the related indexes of ovarian function return to normal after 6 months,the method has no adverse impact on fertility function.