腹腔镜子宫腺肌瘤切除联合子宫动脉阻断术对内膜白血病抑制因子的影响

Impact of laparoscopic uterine artery occlusion combined with resection of adenomyoma on endometrial luekaemia inhibitory factor

目的探讨腹腔镜子宫腺肌瘤切除术联合子宫动脉阻断对子宫内膜容受性的影响及意义。方法选取2014年6月—2015年6月期间就诊福建省立医院妇科的子宫腺肌病(伴子宫腺肌瘤)患者共42例,随机分对照组(n=21)和观察组(n=21),对照组行腹腔镜下子宫腺肌瘤剔除术,观察组行腹腔镜子宫腺肌瘤剔除联合子宫动脉阻断术。所有患者术后均注射长效促性腺激素释放激素类似物(Gn RHa)6个月。比较两组患者平均年龄、最大腺肌瘤、子宫最大径线和CA125水平及患者术前、及术后12个月、24个月子宫内膜容受性标志物——白血病抑制因子(LIF)m RNA水平。结果患者年龄、最大腺肌瘤径线、子宫最大径线及CA125水平组间比较差异均无统计学意义。两组患者术前LIF m RNA(0.73±0.17、0.70±0.18)及术后12个月LIF m RNA(0.98±0.22、0.99±0.22)分别比较差异无统计学意义(P>0.05);术后24个月内膜LIF m RNA观察组(1.02±0.21)明显高于对照组(0.86±0.22)(P=0.022)。结论子宫腺肌瘤病灶切除术联合Gn RHa治疗可改善LIF m RNA的转录;联合子宫动脉阻断术可有助于子宫腺肌瘤病灶切除术的效用,有助于改善子宫内膜容受性。

Objective To observe the impact and the significance of laparoscopic operation of adenomyoma resection on endometrial receptivity with uterine artery occlusion in the operation.Methods Since June 2014 to June 2015, 42 patients with adenomyoma received surgery therapy in Department of Gynecology in Fujian Provincial Hospital, randomly divided into control group （n=21） who received laparoscopic excision of adenomyoma; and observation group （n=21） who received laparoscopic uterine artery occlusion plus excision of adenomyoma. All patients were injected gonadotrophin-releasing hormone analogue （GnRHa） for 6 months. Average age, diameter of the largest adenomyoma, length of uterine before operation and CA125 level were compared. Endometrial luekaemia inhibitory factor （LIF） mRNA level was also compared between the two groups which expressed before operation, the twelfth month after resection and the twenty-fourth month after resection.Results There were no significant differences in average age, diameter of the largest adenomyoma, length of uterine before operation and CA125 level between the two groups. Endometrial LIF mRNA of the two groups before operation （0.73±0.17, 0.70±0.18） and the twelfth month after resection （0.98±0.22, 0.99±0.22） showed no significance difference （P〉0.05） respectively. In the twenty-fourth month, endometrial LIF mRNA was 0.86±0.22 in control group and 1.02±0.21 in observation group, which showed a significance difference （P=0.022）.Conclusion Resection of adenomyoma combined GnRHa can improve endometrial LIF mRNA, combined uterine artery occlusion could enhance the long-term effect of adenomyoma resection which improve the receptivity of endometrial implantation.