双瓣法病灶切除术联合子宫动脉阻断术治疗子宫腺肌病及对SDC-1、HPA和VEGF水平的影响

Impact of double-lobe resection combined with uterine artery occlusion on the level of SDC-1,HPA and VEGF in patients with adenomyosis

目的观察腹腔镜下双瓣法病灶切除术联合子宫动脉阻断术治疗子宫腺肌病的治疗效果及其对多配体蛋白聚糖1(syndecan-1,SDC-1)、乙酰肝素酶(heparanase,HPA)和血管内皮细胞生长因子(vascular endothelial growth factor,VEGF)水平的影响。方法选取子宫腺肌病患者60例,按照手术方式不同分为观察组和对照组各30例。对照组予以双瓣法病灶切除术,观察组在对照组的基础上予以子宫动脉阻断术。观察2组治疗后临床治疗效果和总有效率;比较2组手术时间、术中出血量、术后腹腔引流量、术后腹腔引流时间、手术前后血红蛋白(hemoglobin,Hb)变化值、住院时间和术后10个月总妊娠率等手术相关指标;观察2组治疗前后月经经期、子宫体积、糖类抗原125(carbohydrate antigen 125,CA125)及SDC-1、HPA和VEGF水平的变化。结果观察组临床治疗效果明显优于对照组,总有效率高于对照组,差异均有统计学意义(P<0.01或P<0.05)。观察组手术时间、术中出血量、术后腹腔引流量、术后腹腔引流时间、手术前后Hb变化和住院时间明显短于或者少于对照组(P<0.01),而术后10个月累积妊娠高于对照组(P<0.05)。治疗后,2组月经经期、子宫体积和CA125水平均较治疗前明显缩短、减小或降低(P<0.05);观察组月经经期、子宫体积和CA125水平较对照组明显缩短、减小或降低(P<0.01)。治疗后,2组SDC-1、HPA和VEGF水平均较治疗前明显降低,观察组SDC-1、HPA和VEGF水平较对照组明显降低(P<0.01)。结论腹腔镜下双瓣法病灶切除术联合子宫动脉阻断术治疗子宫腺肌病效果显著,可明显缓解痛经,缩小子宫体积,其机制可能与降低机体SDC-1,HPA和VEGF水平有关。

Objective To observe the efficacy of laparoscopic double-lobe resection combined with uterine artery occlusion in the treatment of adenomyosis and their impact on the levels of syndecan-1(SDC-1),heparanase(HPA)and vascular endothelial growth factor(VEGF).Methods A total of 60 patients with adenomyosis in our hospital were selected and divided into observation group and control group according to different surgical methods.The control group was treated with double valve resection,while the observation group was conducted uterine artery occlusion on the basis of the control group.Clinical curative effect,total effective rate,operation time,intraoperative blood loss,postoperative intraperitoneal drainage volume,postoperative intraperitoneal drainage time,changes in Hb,hospital stays,total pregnancy rate at 10 months after surgery,changes in menstrual period,uterine volume,CA125,SDC-1,HPA and VEGF levels were observed before and after surgery in two groups.Results The clinical curative effect of the observation group was better than that of the control group,and the total effective rate was higher than that of the control group.There was a statistically significant difference(P<0.01 or P<0.05).In the observation group,the operation time,intraoperative bleeding volume,postoperative abdominal drainage volume,postoperative abdominal drainage time,changes of Hb before and after operation and hospitalization time were significantly shorter or less than those in the control group(P<0.01),while the cumulative pregnancy in the 10 months after operation was higher than that in the control group(P<0.05).After treatment,the menstrual period,uterine volume and CA125 level of the two groups were significantly shortened,less or decreased compared with those before treatment,with statistical significance(P<0.01);The menstrual period,uterine volume and CA125 level of the observation group were significantly shortened,less or decreased compared with the control group,with statistical significance(P<0.01).After treatment,the levels of SDC-1,HPA and VEGF in the two groups were significantly lower than those before treatment(P<0.05);The levels of SDC-1,HPA and VEGF in the observation group were significantly lower than those in the control group(P<0.01).Conclusion Laparoscopic double-lobe resection combined with uterine artery occlusion is effective in the treatment of adenomyosis,which can significantly relieve dysmenorrhea and reduce the volume of uterus.The mechanism may be related to the reduction of the levels of SDC-1,HPA and VEGF.