子宫动脉电凝阻断法与止血带阻断法辅助腹腔镜子宫肌瘤剔除术对患者卵巢功能和性功能的影响

Effects of uterine artery electrocoagulation block and tourniquet block assisted with laparoscopic myomectomy on ovarian function and sexual function of patients

目的研究子宫动脉电凝阻断法与止血带阻断法辅助腹腔镜子宫肌瘤剔除术(laparoscopic myomectomy,LM)对患者卵巢功能和性功能的影响。方法选取2015年9月至2018年9月于百色市人民医院行LM治疗的子宫肌瘤患者134例,采用随机数表法将其分为电凝组和止血带组,每组各67例,两组患者均采用子宫动脉阻断术联合LM进行治疗,其中电凝组采用子宫动脉双极电凝进行阻断,止血带组采用止血带阻断法,比较两组患者手术效果及术后卵巢功能和性功能变化情况。结果电凝组患者手术时间明显少于止血带组(P<0.05),两组患者术中出血量、首次排气时间及住院时间比较均无统计学意义(均P>0.05);与术前相比,电凝组患者术后3个月雌二醇(estradiol,E2)明显降低(P<0.05),卵泡刺激素(follicle-stimulating hormone,FSH)明显升高(P<0.05),术后6个月E2和FSH均恢复至术前水平(均P>0.05),止血带组患者术后3个月和6个月E2和FSH水平均未见明显变化(均P>0.05);电凝组患者术后3个月E2显著低于止血带组(P<0.05),FSH显著高于止血带组(P<0.05);术后6个月,两组患者女性性功能指数(female sexual function index,FSFI)量表性欲望、主观性唤起、阴道润滑性、性生活满意度、性高潮、性交痛评分及总分均显著高于术前(均P<0.05),但两组患者各维度评分及总分比较均无统计学意义(均P>0.05)。结论子宫动脉电凝阻断法与止血带阻断法辅助LM治疗子宫肌瘤均具有良好效果,对患者卵巢功能无明显损害且有利于促进性功能改善。

Objective To study the effects of uterine artery electrocoagulation block and tourniquet block assisted with laparoscopic myomectomy(LM)on ovarian function and sexual function of patients.Method A total of 134 patients with uterine fibroids who underwent LM in People's Hospital of Baise from September 2015 to September 2018 were selected and divided into electrocoagulation group and tourniquet group by random number table method,with 67 cases in each group.All patients were given uterine artery block combined with LM,and electrocoagulation group was given uterine artery bipolar electrocoagulation for block,and tourniquet group was treated with tourniquet block.The surgical effects and changes of postoperative ovarian function and sexual function were compared between the two groups.Result The operation time in electrocoagulation group was significantly less than that in tourniquet group(P<0.05),and there were no significant differences in the intraoperative blood loss,first exhaust time and hospital stay between the two groups(all P>0.05).Estradiol(E2)at 3 months after operation in electrocoagulation group was significantly decreased(P<0.05),while follicle-stimulating hormone(FSH)was significantly increased(P<0.05),and the levels of E2 and FSH returned to preoperative levels at 6 months after operation(all P>0.05).There were no significant changes in the levels of E2 and FSH at 3 months and 6 months after operation in tourniquet group(all P>0.05).The level of E2 in electrocoagulation group at 3 months after operation was lower than that in tourniquet group(P<0.05),while the level of FSH was higher than that in tourniquet group(P<0.05).At 6 months after operation,the scores of sexual desire,subjective arousal,vaginal lubricity,sexual life satisfaction,orgasm and dyspareunia and total score of female sexual function index(FSFI)scale in the two groups were significantly higher than those before operation(all P<0.05),and there were no significant differences in scores of dimensions and total score between the two groups(all P>0.05).Conclusion Uterine artery electrocoagulation block and tourniquet block assisted with LM both have good effects in the treatment of uterine fibroids,and they have no obvious damage to the ovarian function and promote the improvement of sexual function.