腹腔镜下子宫肌瘤剔除术对围绝经期子宫肌瘤患者卵巢功能的影响

Effect of laparoscopic myomectomy on the ovarian function in patients with perimenopausal uterine fibroid

目的对比分析腹腔镜下子宫肌瘤剔除术与全子宫切除术治疗围绝经期子宫肌瘤对患者卵巢功能的影响。方法分层整群抽样,回顾分析安徽省第二人民医院2016年1月至2018年12月择期接受手术治疗的43例围绝经期子宫肌瘤患者临床资料,根据患者手术方式分为全切组(n=20)与剔除组(n=23)。剔除组接受腹腔镜下子宫肌瘤剔除术治疗,全切组接受腹腔镜下全子宫切除术治疗,术后随访6个月。分别于术前、术后1个月、6个月,检测并对比两组卵巢功能相关指标[抗苗勒管激素(AMH)、促卵泡激素(FSH)与促黄体生成素(LH)]水平变化情况;分别于术前、术后6个月,采用健康状况调查简表(SF-36)评价患者生活质量;随访结束时,评价记录并对比两组对性生活的满意度。结果术后各时点,剔除组AMH、FSH、LH水平均较术前略降低,差异无统计学意义(P>0.05);全切组AMH水平较术前降低,FSH、LH水平较术前升高,差异具有统计学意义(P<0.05);剔除组各指标水平围术期变化幅度均不及全切组,差异具有统计学意义(P<0.05);术后6个月,剔除组各项评分及总评分均较术前升高,全切组则较术前降低,且显著低于剔除组,差异均具有统计学意义(均P<0.05);剔除组性生活满意率高于全切组,性冷淡发生率低于全切组,差异具有统计学意义(P<0.05)。结论腹腔镜下子宫肌瘤剔除术治疗围绝经期子宫肌瘤并不会对患者卵巢功能造成较大影响,患者术后性生活理想,生活质量提高,若患者条件允许,可作为首选术式。

Objective To compare and analyze the effect of laparoscopic myomectomy(LM)and total hysterectomy(TH)on the ovarian function in patients with perimenopausal uterine fibroid.Methods The stratified cluster sampling was adopted.The clinical data of 43 patients with perimenopausal uterine fibroid with selective surgery from January 2016 to December 2018 were retrospectively analyzed.They were divided into TH group(n=20)and LM group(n=23).LM group was given LM,while TH group was treated with laparoscopic TH,and all were followed up for 6 months after surgery.Before surgery,a month and 6 months after surgery,the ovarian function indexes[anti-mullerian hormone(AMH),follicle-stimulating hormone(FSH),luteinizing hormone(LH)]were compared between the two groups;Before surgery and 6 months after surgery,the quality of life was evaluated by Short Form-36 Health Status Questionnaire(SF-36);At the end of follow-up,the sexual satisfaction were recorded and compared between the two groups.Results At each time after surgery,the levels of AMH,FSH and LH in LM group were slightly lower than those before surgery(P>0.05);The level of AMH in TH group was lower than that before surgery,while the levels of FSH and LH were higher than those before surgery(P<0.05).The perioperative changing range of indexes in LM group was lower than that in TH group(P<0.05).At 6 months after surgery,the scores of each item and total score in LM group were higher than those before surgery,while those in TH group decreased compared with those before surgery and were significantly lower than those in the LM group(all P<0.05).The sexual satisfaction rate of LM group was higher than that of TH group,and the incidence of sexual apathy in LM group was lower than that in TH group,all with statistically significant differences(P<0.05).Conclusions LM in treatment of perimenopausal uterine fibroid does not have a significant impact on the ovarian function.The patients have ideal postoperative sexual life,with improved quality of life.Therefore,LM can be used as the preferred surgery if patients′conditions permit.