腹腔镜下子宫血管阻断术联合子宫肌瘤剜除术治疗子宫肌瘤效果观察

Effect of laparoscopic uterine vascular occlusion combined with uterine fibroid enucleation on patients with uterine fibroids

目的探讨腹腔镜下子宫血管阻断术联合子宫肌瘤剜除术治疗子宫肌瘤的效果及对患者卵泡刺激素（FSH）、黄体生成素（LH）、婚二醇（E2）、孕酮（P）水平的影响。方法选取2015年2月至2017年2月运城第一医院收治的子宫肌瘤患者89例，以随机数字表法将其分为研究组45例与对照组44例。对照组给予腹腔镜下子宫肌瘤剜除术治疗，研究组给予腹腔镜下子宫血管阻断术联合子宫肌瘤剜除术治疗。对两组患者均进行6个月的随访观察。比较两组各项手术指标，术前及术后3、6个月的血清FSH、LH、E2、P水平，子宫恢复正常与复发情况，术后并发症与中转开腹发生情况。结果研究组术中失血量、手术时间及住院时间分剐为（81．48±12．85）ml、（87．25±15．28）min、（7．2l±2．05）d，均低于对照组[（97．74±16．23）ml、（108．70±19．31）rain、（8．89±2．24）d]，两组比较差异有统计学意义（P均〈0．05）。术前两组血清FSH、LH、E2、P水平比较差异未见统计学意义（P均〉0．05）；术后3个月研究组FSH水平比术前明显升高，而E2水平明显降低，差异有统计学意义（P均〈0．05）；术后3、6个月，对照组上述各项指标水平与术前比较差异未见统计学意义（P均〉0．05）。研究组子宫恢复正常例数占95．56％（43／45），高于对照组[81．82％（36／44）]；复发例数占2．22％（1／45），低于对照组[13．64％（6／44）]，组间比较差异有统计学意义（P均〈0．05）。研究组并发症、中转开腹例数占比与对照组比较差异未见统计学意义（P均〉0．05）。结论腹腔镜下子宫血管阻断术联合子宫肌瘤剜除术治疗子宫肌瘤可有效减少术中失血量，缩短手术时间，有利于患者旱日康复，且可有效促进患者子宫恢复正常，降低复发率。

Objective To study the effects of laparoscopic hysteroscopy combined with hysteromyoma enucleation on the levels of follicle stimulating hormone （FSH）, luteinizing hormone （LH）, estradiol （E2） and progesterone （P） in patients. Methods Eighty-nine cases of uterine fibroids admitted to the First Hospital of Yuncheng from February 2015 to February 2017 were selected. The 89 patients were divided into 45 eases in research group and 44 cases in control group by random number table method. The control group was treated with laparoscopic myomectomy, and the research group was treated with laparoscopic uterine vascular occlusion combined with uterine myomcctomy. All the patients in the two groups were followed up for 6 months. The operation indicators, preoperative and 3 months, 6 months after operation,the serum FSH, LH, E2, P level, returned to normal uterus and relapse, and the postoperative complications occurrence and transfer laparotomy of the two groups were compared. Results The amount of blood loss, operation time and hospitalization time in the study group were （81.48 ± 12.85） ml, （87.25 ± 15.28） rain and （7.21 ±2.05） d respectively, which were significantly lower than those of the control group [ （97.74 ± 16. 23 ） ml, （ 108.70 ± 19.31 ） rain and （ 8.89 ± 2. 24） d ] , and the differences were significant （ P all 〈 0. 05 ）. The serum FSH, LH, E2 and P levels were not significantly different between the two groups before surgery （P all 〉 0. 05 ）. Three months after surgery, the FSH level of the study group was higher than that before surgery, while the E2 level was lower, and the differences were significant （ P all 〈 0.05 ）. Three months, 6 months after surgery, the above indexes of the control group were not significantly different compared with those before surgery （P all 〉0. 05）. The team returned to normal uterus number accounting for 95.56% （43/45）, which was significantly higher than that of the control group [ 81.82% （36/44）], and the number of recurrence ratio was 2.22% （ 1/45 ）, which was significantly lower than that of the control group [ 13.64% （ 6/44 ） ], the differences between the two groups were significant （ P all 〈 0. 05 ）. The proportion of complications and conversion to laparotomy in study group were not significantly different from those in the control group （P 〉 O. 05 ）. Conclusions Laparoscopic hysteromyoma combined with hysteromyoma enucleation in the treatment of uterine myoma can effectively reduce the amount of blood loss, shorten the operation time, and be beneficial to the recovery of the patients as soon as possible, and can effectively promote the recovery of the uterus and reduce the recurrence rate.