腹腔镜子宫肌瘤剥除术配合围手术期盆腹康复治疗的疗效观察

Efficacy of laparoscopic myomectomy combined with perioperative pelvic and abdominal rehabilitation training in patients with uterine fibroids

目的 探讨子宫肌瘤患者采用腹腔镜子宫肌瘤剥除术配合围手术期盆腹康复治疗后盆底功能、内分泌功能及生育功能的变化情况。方法 前瞻性选取2019年1月至2021年12月间上海市第一人民医院和南京医科大学附属苏州市立医院收治的90例子宫肌瘤患者,采用随机数表法分为A组和B组,每组45例。A组患者采用腹腔镜子宫肌瘤剥除术,B组患者采用腹腔镜子宫动脉阻断术,两组患者均于围手术期配合盆腹康复治疗,比较两组患者的盆底功能、内分泌功能及生育功能。结果 A组患者盆底功能指标优于B组,A组患者总有效率为75.6%,高于B组的53.3%,差异有统计学意义(P<0.05)。干预后24周,两组患者卵泡激素、促黄体生成素、孕酮和雌二醇指标均改善,且A组均优于B组,差异均有统计学意义(均P<0.05)。干预后24周,两组患者性欲望、性高潮、性交流和性兴奋均有改善,A组均优于B组,且A组患者的妊娠成功率(88.9%)高于B组(62.2%),差异均有统计学意义(均P<0.05)。结论 子宫肌瘤患者采用腹腔镜子宫肌瘤剥除术配合围手术期盆腹康复治疗,临床效果较好,可有效改善患者的盆底功能和内分泌功能,且不会对生育功能产生较大影响,值得推广。

Objective To explore and analyze the changes in pelvic floor function, endocrine function and reproductive function in patients with uterine fibroids after laparoscopic myomectomy combined with perioperative pelvic and abdominal rehabilitation. Methods Ninety patients with uterine fibroids who were treated at Shanghai First People’s Hospital and Suzhou Municipal Hospital Affiliated to Nanjing Medical University were prospectively enrolled from January 2019 to December 2021. They were randomly divided into group A and group B using random table method with 45 patients each. Group A were treated with laparoscopic myomectomy and group B underwent laparoscopic uterine artery occlusion. Both groups received pelvic and abdominal rehabilitation training during the perioperative period. The pelvic floor function, endocrine function and reproductive function were compared between the two groups. Results The pelvic floor function indexes of patients were significantly better in group A than in group B(all P<0.05). The overall efficacy rate was 75.6% in group A which was higher than 53.3% of group B(P<0.05). At 24 weeks after intervention, follicle stimulating hormone(FSH), luteinizing hormone(LH), progesterone and estradiol were improved in both groups compared with those before the intervention with group A better than group B(all P<0.05). At 24 weeks after intervention, sexual desire, orgasm, sexual communication and sexual excitement were improved in both groups compared with those before the intervention with group A better than group B(all P<0.05). The success rate of pregnancy was 88.9% in group A which was higher than 62.2% of group B(P<0.05). Conclusion Laparoscopic myomectomy combined with perioperative pelvic and abdominal rehabilitation therapy is effective for uterine fibroids. It can effectively improve the pelvic floor function and endocrine function without greatly ifluencong the reproductive, which is worthy of promotion.