HEOS宫腔镜手术在子宫肌瘤患者中的应用及对卵巢功能、创伤反应指标的影响

Application of HEOS hysteroscopic surgery in patients with uterine fibroids and its effect on ovarian function and trauma response indicators

目的:探讨双重宫腔镜手术系统(HEOS)宫腔镜手术治疗子宫肌瘤患者的效果及对卵巢功能、创伤反应指标的影响。方法:回顾性分析商丘市第五人民医院2020年1月至2023年3月收治的104例子宫肌瘤患者的病例资料,按手术方案不同分为2组,其中接受HEOS宫腔镜手术治疗的52例患者为HEOS组,接受常规宫腔镜电切术(TCRPR)治疗的52例患者为TCRPR组。对比2组手术及术后恢复指标、手术效果、手术前后卵巢功能[雌二醇(E_(2))、促黄体生成激素(LH)、促卵泡生成激素(FSH)]、创伤反应指标[白细胞介素-6 (IL-6)、白细胞介素-17 (IL-17)、血管紧张素Ⅱ(AngⅡ)]、并发症发生率。结果:HEOS组手术用时、术后排气时间、白细胞计数恢复正常时间、住院时间短于TCRPR组,术中失血量少于TCRPR组(P<0.01);术后1 d,2组血清IL-6、IL-17、AngⅡ水平高于术前,HEOS组术后1 d血清IL-6、IL-17、AngⅡ水平低于TCRPR组(P<0.05);HEOS组手术优良率为98.08%(51/52),高于TCRPR组的84.62%(44/52)(P<0.05);术后3个月,2组血清E_(2)水平低于术前,血清LH、FSH水平高于术前,HEOS组血清E_(2)水平低于TCRPR组,血清LH、FSH水平高于TCRPR组(P<0.05);HEOS组并发症发生率为1.92%(1/52),低于TCRPR组的17.31%(9/52)(P<0.05)。结论:相较于常规TCRPR治疗子宫肌瘤患者,经HEOS宫腔镜手术治疗更有助于提升手术效果,优化手术及术后恢复指标,改善卵巢功能,减少并发症,且对机体产生创伤反应更小。

Objective:To explore the therapeutic effect of HEOS hysteroscopic surgery on patients with uterine fibroids and its effect on ovarian function and trauma response indicators.Methods:The clinical data of 104 patients with uterine fibroids admitted to Shangqiu Fifth People's Hospital from Jan 2020 to Mar 2023 were retrospectively analyzed and were divided into 2 groups according to different surgical protocols.A total of patients who underwent HEOS hysteroscopic surgery were enrolled in HEOS group and 52 patients who underwent conventional hysteroscopic electroresection(TCRPR)were enrolled in TCRPR group.The surgical and postoperative recovery indicators,surgical effects,ovarian function before and after surgery[estradiol(E_(2)),luteinizing hormone(LH),follicle-stimulating hormone(FSH)],trauma response indicators[interleukin-6(IL-6),interleukin-17(IL-17),angiotensinⅡ(AngⅡ)],and incidence of complications were compared between the two groups.Results:The operation time,postoperative exhaust time,time of the white blood cell count returning to normal,and hospitalization time in HEOS group were shorter than those in TCRPR group,and the intraoperative blood loss was less than that in TCRPR group(P<0.01).At 1 d after operation,serum levels of IL-6,IL-17 and AngⅡin 2 groups were higher than those before operation,and serum levels of IL-6,IL-17 and AngⅡin HEOS group were lower than those in TCRPR group(P<0.01).The excellent and good rate of operation in HEOS group was 98.08%(51/52),which was higher than that in TCRPR group[84.62%(44/52)](P<0.05).At 3 months after operation,the serum E_(2) level was lower and the serum LH and FSH levels of 2 groups were higher than those before operation,and the serum E_(2) level of HEOS group was lower than that of TCRPR group,and the serum LH and FSH levels were higher than those of TCRPR group(P<0.01).The incidence of complications in HEOS group was 1.92%(1/52),which was lower than that of TCRPR group[17.31%(9/52)](P<0.05).Conclusion:Compared with conventional TCRPR in the treatment of uterine fibroids,hysteroscopic surgery with HEOS is more helpful to improve the surgical effect,optimize the surgical and postoperative recovery indicators,improve ovarian function,reduce complications,and had less traumatic reactions.