SPLM与MPLM治疗子宫肌瘤的疗效及对卵巢功能、宫颈局部微循环的影响

Efficacy of single port laparoscopic myomectomy and multiport laparoscopic myomectomy in the treatment of uterine fibroids and their impact on ovarian function and local cervical microcirculation

目的探讨经脐单孔腹腔镜子宫肌瘤剔除术(SPLM)与多孔腹腔镜子宫肌瘤剔除术(MPLM)治疗子宫肌瘤的疗效及对卵巢功能、宫颈局部微循环的影响。方法回顾性分析2019年2月至2021年12月期间在汉中市南郑区人民医院妇产科治疗的200例子宫肌瘤患者的临床资料。按治疗手术方式不同分为治疗1组和治疗2组各100例,治疗1组患者采用SPLM治疗,治疗2组患者采用MPLM治疗。比较两组患者治疗效果、临床指标{术中失血量、手术时间、排气时间、术后24 h、48 h疼痛程度[参照视觉模拟评分量表(VAS)]},并比较两组患者术前、术后3个月的卵巢功能指标[雌二醇(E2)、促黄体生成素(LH)、促卵泡生成激素(FSH)、窦状卵泡数(AFC)],以及术前、术后7 d的宫颈局部微循环指标[毛细血管管径、血流灌注]和并发症发生情况。结果治疗1组和治疗2组患者的治疗总有效率分别为99.00%、97.00%,差异无统计学意义(P>0.05);治疗1组患者术中失血量、排气时间分别为(92.85±10.36)m L、(19.78±4.68)h,明显低(短)于治疗2组的(121.79±11.29)m L、(24.16±4.38)h,差异均有统计学意义(P<0.05);治疗1组患者的手术时间为(70.36±13.68)min,明显长于治疗2组的(54.35±10.52)min,差异有统计学意义(P<0.05);两组患者术后24 h和术后48 h的VAS评分比较差异均无统计学意义(P>0.05);术前,两组患者的E2、LH、FSH、AFC比较差异均无统计学意义(P>0.05);术后3个月,两组患者的E2、LH、FSH、AFC水平均较术前降低,差异均有统计学意义(P<0.05),但两组患者术后3个月的E2、LH、FSH、AFC水平比较差异均无统计学意义(P>0.05);术后7 d,两组患者的毛细血管管径、血流灌注均较术前升高,差异均有统计学意义(P<0.05),但术后7 d,两组患者的毛细血管管径、血流灌注比较差异均无统计学意义(P>0.05);治疗1组和治疗2组患者的并发症发生率分别为6.0%、8.0%,差异无统计学意义(P>0.05)。结论SPLM与MPLM两种方式治疗子宫肌瘤均能明显改善患者术后卵巢功能、宫颈局部微循环情况,虽然SPLM治疗患者术中失血量较少,MPLM治疗患者手术时间短,但两种方式安全性均较高,具有临床应用价值。

Objective To investigate the efficacy of single port laparoscopic myomectomy(SPLM)and multi port laparoscopic myomectomy(MPLM)in the treatment of uterine fibroids,and their impact on ovarian function and local cervical microcirculation.Methods The clinical data of 200 patients with uterine fibroids treated in the Department of Obstetrics and Gynecology,Hanzhong Nanzheng District People's Hospital from February 2019 to December 2021 were retrospective analyzed.According to different surgical methods,all patients were divided into treatment group A and treatment group B,with 100 patients in each group.The patients in the treatment group A received SPLM treatment,while the patients in the treatment group B received MPLM treatment.The treatment effect,clinical indicators[intraoperative blood loss,surgical time,exhaust time,postoperative pain level at 24 hours and 48 hours(refer to visual analogue scale,VAS)were compared between the two groups,and the ovarian function indicators[estradiol(E2),luteinizing hormone(LH),follicle stimulating hormone(FSH),sinus follicle count(AFC)]before and 3 months after surgery,as well as the local cervical microcirculation indicators of the cervix[capillary diameter,blood flow perfusion],and the occurrence of complications before and 7 days after surgery were compared.Results The total effective rates of treatment in the treatment group A and treatment group B were 99.00%and 97.00%,and the differences were not statistically significant(P>0.05).The intraoperative blood loss and exhaust time in the treatment group A were(92.85±10.36)mL and(19.78±4.68)h,which were significantly lower(shorter)than(121.79±11.29)mL and(24.16±4.38)h in the treatment group B(P<0.05).The surgical time in the treatment group A was(70.36±13.68)min,which was significantly longer than(54.35±10.52)min in the treatment group B(P<0.05).There was no statistically significant difference in VAS scores between the two groups of patients at 24 h and 48 h after surgery(P>0.05).Before surgery,there was no statistically significant difference in E2,LH,FSH,and AFC between the two groups(P>0.05).At 3 months after surgery,the levels of E2,LH,FSH,and AFC in both groups of patients decreased compared with those before surgery,and the differences were statistically significant(P<0.05).However,there was no statistically significant difference in E2,LH,FSH,and AFC levels between the two groups at 3 months after surgery(P>0.05).At the 7 d after surgery,the capillary diameter and blood flow perfusion of the two groups increased compared with those before surgery,and the differences were statistically significant(P<0.05).However,there was no statistically significant difference in capillary diameter and blood flow perfusion between the two groups at 7 d after surgery(P>0.05).The incidence of complications in treatment group A and treatment group B was 6.0%and 8.0%,with no statistically significant difference(P>0.05).Conclusion Both SPLM and MPLM methods can significantly improve postoperative ovarian function and local cervical microcirculation in patients with uterine fibroids.Although patients treated with SPLM had less intraoperative blood loss and MPLM had shorter operation time,both methods have high safety and clinical application value.