腹腔镜联合宫腔镜子宫肌瘤剔除术的疗效及其对患者血清IMA、MYO表达和卵巢功能的影响

Effects of laparoscopy combined with hysteroscopic hysteromyomectomy and its influence on serum IMA,MYO expressions and ovarian function

目的:探讨腹腔镜联合宫腔镜子宫肌瘤剔除术的疗效及其对患者血清缺血修饰白蛋白(IMA)、肌红蛋白(MYO)表达以及卵巢功能的影响。方法:选取2017年1月至2018年2月河南省直第三人民医院收治的92例子宫肌瘤患者作为研究对象,将其随机分为观察组和对照组,每组46例。对照组行传统开腹子宫肌瘤剔除术,观察组行腹腔镜联合宫腔镜子宫肌瘤剔除术。比较两组手术相关指标,比较两组术前及术后24、72 h血清IMA、MYO水平,比较两组术前及术后3个月卵巢功能[卵泡刺激素(FSH)、促黄体生成素(LH)]、并发症发生率,术后2年复发率及成功妊娠率。结果:观察组术中出血量少于对照组,手术时间、肛门排气时间、住院时间短于对照组(P<0.05)。术后24、72 h,观察组血清IMA、MYO水平低于对照组(P<0.05)。术后3个月,观察组FSH、LH水平低于对照组(P<0.05)。观察组并发症发生率(4.35%,2/46)低于对照组(19.57%,9/46),P<0.05。术后2年,对照组复发率为12.50%(5/40),成功妊娠率为34.88%(15/40);观察组复发率为4.65%(2/43),成功妊娠率为39.53%(17/43),两组复发率、成功妊娠率比较差异未见统计学意义(P>0.05)。结论:腹腔镜联合宫腔镜子宫肌瘤剔除术能有效减少术中出血量,缩短手术时间及术后恢复时间,减轻氧化应激,促进患者卵巢功能恢复,降低并发症发生率,且远期效果与传统开腹手术相当。

Objective:To investigate the effects of laparoscopy combined with hysteroscopic hysteromyomectomy,and its influence on serum ischemia-modified albumin(IMA)and myoglobin(MYO)expression,and ovarian function.Methods:A total of 92 patients with uterine fibroids treated in the Third People’s Hospital of Henan Province from January 2017 to February 2018 were selected as the research object.All of the patients were randomly divided into observation group and control group,with 46 cases in each group.The control group underwent traditional laparoscopic myomectomy,and the observation group underwent laparoscopic combined with hysteroscopic myomectomy.The operation-related indicators,expressions of serum IMA,MYO before operation and 24 and 72 h after operation,preoperative and postoperative 3-month ovarian function assessed by follicle stimulating hormone(FSH)and luteinizing hormone(LH),incidence of complications,postoperative 2-years recurrence rate and the successful pregnancy rate were compared between the two groups.Results:The intraoperative bleeding volume in the observation group was less than that in the control group,while the operation time,anal exhaust time,and hospitalization time were shorter than those in the control group(P<0.05).The levels of serum IMA and MYO in the observation group at 24 and 72 hours after operation were lower than those in the control group(P<0.05).The levels of FSH and LH in the observation group were lower than those in the control group 3 months after operation(P<0.05).The incidence of complications in the observation group(4.35%,2/46)was lower than that in the control group(19.57%,9/46),P<0.05.The recurrence rate and pregnancy rate 2 years after treatment of the control group were 12.50%(5/40)and 34.88%(15/40),respectively,and the two indexes of the observation group were 4.65%(2/43)and 39.53%(17/43),respectively,and there was no significant difference between the two groups in recurrence rate and successful pregnancy rate(P>0.05).Conclusions:Laparoscopy combined with hysteroscopic myomectomy can effectively reduce intraoperative bleeding volume,shorten operation time and postoperative recovery time,reduce oxidative stress,promote the recovery of ovarian function,and reduce incidence of complications,which has comparable long-term effect to traditional open surgery.