腹腔镜下子宫肌瘤剔除术对子宫肌瘤患者术后卵巢功能及自然妊娠结局的影响

Effects of laparoscopic myomectomy on ovarian function and natural pregnancy outcome of patients with uterine fibroids

目的探讨腹腔镜下子宫肌瘤剔除术对子宫肌瘤患者术后卵巢功能及自然妊娠结局的影响。方法抽取2016年3月至2020年3月在商丘市中心医院接受治疗的200例子宫肌瘤患者作为研究对象,按照手术方式分为对照组(98例)和观察组(102例)。对照组给予开腹子宫肌瘤剔除术,观察组给予腹腔镜下子宫肌瘤剔除术,比较两组患者术后卵巢功能指标、手术指标、术后并发症、残留率、复发率及自然妊娠结局。结果术前,两组患者雌二醇、促卵泡刺激素(FSH)、促黄体生成素(LH)水平比较差异未见统计学意义(P>0.05);术后6个月,观察组雌二醇水平高于对照组,FSH、LH水平低于对照组(P<0.05)。观察组的手术时间为(95.56±4.54)min,长于对照组的(80.24±3.67)min(P<0.05);术中出血量、术后肛门首次排气时间、住院时间少于对照组(P<0.05)。观察组术后并发症发生率(7.84%,8/102)低于对照组(17.35%,17/98),P<0.05。对照组术后无残留,复发率为5.10%(5/98);观察组患者术后肌瘤残留率为4.90%(5/102),复发率为9.80%(10/102),两组比较差异未见统计学意义(P>0.05)。观察组自然妊娠率为39.33%(35/89),对照组为37.50%(33/88),差异未见统计学意义(P>0.05)。结论与开腹子宫肌瘤剔除术相比,腹腔镜下子宫肌瘤剔除术手术时间更长,但手术恢复更快,对卵巢功能损伤更小,可降低术后并发症发生率,两组肌瘤残留率、复发率及自然妊娠率未见明显差异。

Objective To investigate the effects of laparoscopic myomectomy on ovarian function and natural pregnancy outcome of patients with uterine fibroids.Methods A total of 200 patients with uterine fibroid who were treated in Shangqiu Central Hospital from March 2016 to March 2020 were selected as the research subjects.They were divided into control group(n=98)and observation group(n=102)according to surgical methods.The control group was treated by open myomectomy,and the observation group was treated by laparoscopic myomectomy.The postoperative ovarian function indexes,surgical indexes,postoperative complications,residual rate,recurrence rate,and natural pregnancy outcome were compared between the two groups.Results There was no significant difference in the levels of estradiol,follicle stimulating hormone(FSH),or luteinizing hormone(LH)between the two groups before surgery(P>0.05).Estradiol level in the observation group was higher than that in the control group,and levels of FSH and LH in the observation group were lower than those in the control group 6 months after surgery(P<0.05).The operation time of the observation group was(95.56±4.54)min,longer than the(80.24±3.67)min of the control group(P<0.05).The amount of intraoperative blood loss,postoperative initial anal exhaust time,and hospital stay of the observation group were less than those of the control group(P<0.05).The incidence of complications in the observation group(7.84%,8/102)was lower than that in the control group(17.35%,17/98),P<0.05.There was no residual in the control group after surgery,and the recurrence rate was 5.10%(5/98).The postoperative residual rate and recurrence rate in the observation group were 4.90%(5/102)and 9.80%(10/102),respectively,but the difference was not significant between the two groups(P>0.05).The natural pregnancy rates of observation group and control group were 39.33%(35/89)and 37.50%(33/88),respectively,P>0.05.Conclusions Compared with open myomectomy,laparoscopic myomectomy has longer operation time,however,faster recovery,less damage to ovarian function.And it can reduce the incidence of postoperative complications.There is no significant difference in residual rate,recurrence rate or pregnancy rate of patients treated by the two surgeries.