子宫肌瘤剔除术对卵巢功能、血清疼痛指标水平的影响及临床疗效分析

Analysis on influence of myomectomy on ovarian function and levels of serum pain indexes and the clinical curative effect

目的研究子宫肌瘤剔除术对卵巢功能、血清疼痛指标水平的影响及临床治疗效果。方法选取2015年1月-2016年2月在巴中市中心医院治疗的子宫肌瘤患者80例,参考随机数字表法,按照1∶1比例将纳入患者随机分为观察组和对照组,每组40例。观察组采用腹腔镜下子宫肌瘤剔除术、对照组采用腹腔镜下子宫全切除术或子宫次全切除术,比较两组患者手术时间、术中出血量、住院时间、肌瘤复发率,术前、术后1个月、3个月卵巢功能和术后24 h、72 h血清疼痛指标水平及术后3个月、6个月围绝经期症状。结果观察组平均手术时间、平均术中出血量均少于对照组,差异均有统计学意义(均P<0.05)。平均术后肛门排气时间、平均住院时间少于对照组,差异均有统计学意义(均P<0.05)。术后3个月、6个月内子宫肌瘤复发率2.50%、2.50%与对照组0.00%、0.00%比较,差异无统计学意义(均P>0.05)。术后3个月、6个月内妊娠率10.00%、17.50%高于对照组的0.00%、0.00%,差异均有统计学意义(均P<0.05)。术后1个月、3个月,观察组血清雌二醇水平高于对照组;平均卵泡刺激素平均水平和促黄体生成素水平均低于对照组,差异均有统计学意义(均P<0.05)。术后24 h、72 h,观察组白介素-6平均水平和前列腺素E_2平均水平低于对照组,差异均有统计学意义(均P<0.05)。术后3个月、6个月,观察组轻度症状构成比2.50%、5.00%,中度症状构成比0.00%、0.00%,重度症状构成比0.00%、0.00%,均低于对照组轻度症状构成比22.50%、35.00%,中度症状构成比12.50%、22.50%,重度症状构成比2.50%、10.00%,差异均有统计学意义(均P<0.05)。结论子宫肌瘤剔除术治疗子宫肌瘤效果显著,且避免了对卵巢功能的过度影响,减轻对机体造成的创伤,但选取何种手术方式还应根据患者年龄、是否存在生育意愿、曾经是否进行过类似手术及肌瘤位置、大小、数量、疑似恶变程度等具体情况选取相应个体化手术治疗方案,方能提高临床疗效。

Objective To research the influence of myomectomy on ovarian function and levels of serum pain indexes and the clinical curative effect. Methods From January 2015 to February 2016,80 patients with uterine fibroid treated in Bazhong Central Hospital were selected and divided into observation group and control group according to random number table,40 patients in each group. The patients in observation group were treated with laparoscopic myomectomy,and the patients in control group were treated with total laparoscopic hysterectomy or subtotal laparoscopic hysterectomy. The operation time,the amount of intraoperative blood loss,hospitalization time,recurrence rate of uterine fibroid,ovarian function before operation,at one and three months after operation,the levels of serum pain indexes at 24 and 72 hours after operation,perimenopausal symptoms at 3 and 6 months after operation in the two groups were compared. Results The mean operation time and mean amount of intraoperative blood loss in observation group were statistically significantly lower than those in control group（ P〈0. 05）. The mean postoperative anal exhausting time and mean hospitalization time in observation group were statistically significantly lower than those in control group（ P〈0. 05）. The recurrence rates of uterine fibroid at 3 and 6 months after operation in observation group were 2. 50% and 2. 50%,respectively; the recurrence rates of uterine fibroid at 3 and 6 months after operation in control group were 0. 00% and 0. 00%,respectively; there was no statistically significant difference between the two groups（ P〉0. 05）. The pregnancy rates at 3 and 6 months after operation in observation group were 10. 00% and 17. 50%,respectively,which were statistically significantly higher than those in control group（ 0. 00% and 0. 00%,respectively）（ P〈0. 05）. At 1 and 3 months after operation,the levels of serum estradiol in observation group were statistically significantly higher than those in control group（ P〈0. 05）. At 1 and 3 months after operation,the levels of follicle-stimulating hormone（ FSH） and luteinizing hormone（ LH） in observation group were statistically significantly lower than those in control group（ P〈0. 05）. At 24 and 72 hours after operation,the levels of interleukin-6 and prostaglandin E in observation group were statistically significantly lower than those in control group（ P〈0. 05）. At 3 and 6 months after operation,the proportions of mild symptoms in observation group were 2. 50% and 5. 00%,respectively,the proportions of moderate symptoms in observation group were 0. 00% and0. 00%,respectively,the proportions of severe symptoms in observation group were 0. 00% and 0. 00%,respectively,which were statistically significantly lower than those in control group（ 22. 50%,35. 00%; 12. 50%,22. 50%; 2. 50%,10. 00%）（ P〈0. 05）. Conclusion The curative effect of myomectomy in treatment of uterine fibroid is significant,the operation avoids the excessive influence on ovarian function,relieve the injury on patients,corresponding individualized operation methods should be selected according to age,having fertility desire,undergoing similar operation or not,location,size,number,suspicious malignant degree of uterine fibroid to improve clinical effect.