子宫动脉阻断对腹腔镜腺肌病灶切除长期疗效的价值

Clinical value of uterine artery occlusion in long-term effecs of laparoscopic adenomyomectomy

目的研究子宫动脉阻断(uterine artery occlusion,UAO)对腹腔镜子宫腺肌病灶切除术长期疗效的临床应用价值。方法采用前瞻性队列研究方法,选取2010年1月至2015年1月在首都医科大学附属北京妇产医院妇科微创中心行腹腔镜子宫腺肌病灶切除术的102例患者为研究对象,其中行腹腔镜子宫腺肌病灶切除联合UAO 68例(研究组),单纯腹腔镜子宫腺肌病灶切除34例(对照组),分析比较两组的手术时间、术中出血量、手术前后血红蛋白变化、术后最高体温、术后痛经评分、经量评分及复发率。结果与对照组相比,研究组术中出血量明显减少[(120. 30±121. 20) ml vs(176. 00±149. 25) ml],差异有统计学意义(P <0. 05);两组手术时间、手术前后血红蛋白变化、术后住院时间均无明显差异(P> 0. 05);术后3年,两组的复发率(20. 6%vs 23. 5%)、痛经评分[(2. 69±1. 04)分vs(2. 78±1. 27)分]、经量评分[(1. 24±0. 45)分vs (1. 38±0. 30)分]均无显著差异(P> 0. 05)。结论 UAO可以减少腹腔镜子宫腺肌病灶切除术中出血,但对此手术远期疗效无明显改善作用。

Objective Investigate the clinical application value of uterine artery occlusion in long- term effects of laparoscopic adenomyectomy. Methods A prospective cohort study of patients undergoing laparoscopic adenomyectomy combided with artery occlusion（study group, n =68） was carried out in Beijing Obstetrics and Gynecology Hospital from Jan. 2010 to Jan.2015. 34 patients undergoing simple laparoscopic adenomyectomy in the same period was selected as the control group. For the comparision of the two groups, the operation duration,blood loss during operation,postoperative maximum temperature, the length of postoperative hospitalization,postoperative hemoglobin change,postoperative dysmenorrhea score, menstrual score and recurrence rate were observed. Results Compared with control group,the patients of study group show significant less blood loss during operation [（120.30±121.20）ml vs （176.00±149.25）ml] （ P 〈 0.05） . There was no significant difference in the operation duration,blood loss during operation,postoperative maximum temperature, postoperative hemoglobin change between the two groups （ P 〉 0.05）. There was no significant difference in recurrence rate （20.6% vs 23.5%）, menstrual score[（1.24± 0.45） vs （1.38±0.30）] and dysmenorrhea score[（2.69±1.04） vs （2.78±1.27）] between two groups three years after operation. Conclusions Uterine artery occlusion are effective on reducing blood loss during operation,but it may be unuseful in improving long- term clinical outcomes of laparoscopic adenomyectomy.