开腹子宫肌瘤剔除术与全子宫切除术治疗子宫肌瘤的效果比较

Comparison of the therapeutic effects of open abdominal myomectomy and total hysterectomy on uterine fibroids

目的分析开腹子宫肌瘤剔除术和全子宫切除术治疗子宫肌瘤的临床效果。方法回顾性分析2020年10月至2023年10月信阳一五四医院收治的92例子宫肌瘤患者的临床资料,根据随机数字表法将纳入患者分为肌瘤剔除组与子宫全切组,每组46例。子宫全切组采用全子宫切除术,肌瘤剔除组采用开腹子宫肌瘤剔除术。比较两组围术期指标、视觉模拟评分法(VAS)评分及并发症发生率。比较两组手术前后性激素[雌二醇、促黄体生成素(LH)、卵泡刺激素(FSH)]水平及性功能[女性性功能量表(FSFI)评分]。结果肌瘤剔除组术中出血量少于子宫全切组,手术时间、肛门排气时间、住院时间短于子宫全切组(P<0.05)。术后6、12、24 h,肌瘤剔除组VAS评分低于子宫全切组(P<0.05)。术后3个月,肌瘤剔除组雌二醇水平高于子宫全切组,LH、FSH水平低于子宫全切组(P<0.05)。术后3个月,肌瘤剔除组FSFI评分高于子宫全切组(P<0.05)。肌瘤剔除组并发症发生率(4.35%,2/46)低于子宫全切组(19.57%,9/46),P<0.05。结论与全子宫切除术相比,开腹子宫肌瘤剔除术治疗子宫肌瘤可减轻卵巢功能损伤、对性功能的影响及手术创伤,并降低术后疼痛度和并发症发生率,利于患者术后恢复。

ObjectiveTo compare the effects of open abdominal myomectomy and total hysterectomy in the treatment of uterine fibroids.MethodsThe clinical data of 92 patients with uterine fibroids who were treated in Xinyang No.154 Hospital from October 2020 to October 2023 were retrospectively analyzed.And the 92 patients were divided into a myomectomy group and a total hysterectomy group by random number table method,with 46 cases in each group.The total hysterectomy group was treated by total hysterectomy,and the myomectomy group was treated by open abdominal myomectomy.The perioperative indicators,visual analogue scale(VAS)score,and incidence of adverse reactions were compared between the two groups.The preoperative and postoperative sex hormones including estradiol,luteinizing hormone(LH)and follicle stimulating hormone(FSH),and sexual function assessed by female sexual function index(FSFI)score were compared between the two groups.ResultsCompared with the total hysterectomy group,the myomectomy group had less intraoperative blood loss,shorter operation duration,shorter anal exhaust time,and shorter hospital stay(P<0.05).At 6,12 and 24 hours after treatment,the VAS scores of the myomectomy group were significantly lower than those of the total hysterectomy group(P<0.05).The myomectomy group had higher estradiol level,lower LH level and lower FSH level compared with the total hysterectomy group 3 months after treatment(P<0.05).The 3-month postoperative FSFI score of the myomectomy group was higher than that of the total hysterectomy group(P<0.05).The incidence of complications in the myomectomy group(4.35%,2/46)was lower than that in the total hysterectomy group(19.57%,9/46),P<0.05.ConclusionsCompared with total hysterectomy,open abdominal myomectomy for uterine fibroids can reduce impact on ovarian function,influence on sexual function and surgical trauma;moreover,it can reduce postoperative pain and incidence of complications,so as to accelerate postoperative recovery.