子宫动脉栓塞术和微创肌瘤切除术的疗效比较

Comparison of the efficacy of uterine artery embolization and minimally invasive myomectomy

目的比较子宫动脉栓塞术和子宫肌瘤切除对子宫肌瘤患者子宫体积、卵巢功能和生殖内分泌功能的影响。方法选取2011年1月至2017年12月重庆市沙坪坝区新桥医院妇产科诊治的300例子宫肌瘤患者为研究对象。根据手术方式的不同,将300例子宫肌瘤患者分为观察组(n=159)和对照组(n=141)。观察组患者行子宫动脉栓塞术,对照组患者行腹腔镜下子宫肌瘤切除术。比较两组患者手术相关指标和临床症状改善情况。采用全自动免疫发光分析仪测定患者手术前后激素水平,调查患者月经恢复时间、月经周期、恢复排卵时间和自然妊娠时间。结果与对照组患者相比,观察组患者术中出血量降低、手术时间和住院时间缩短,两者差异均具有统计学意义(均P<0.05)。观察组患者术后感染发生率低于对照组患者,两者差异具有统计学意义(P<0.05)。术前,两组患者子宫体积差异无统计学意义(P>0.05);术后,两组患者子宫体积均小于术前,观察组患者子宫体积大于对照组,其差异具有统计学意义(P<0.05)。术后3个月,两组患者FSH和LH水平高于术前、E2水平低于术前,且观察组患者FSH和LH水平低于对照组、E2水平高于对照组(P<0.05)。两组患者月经恢复时间、月经周期、恢复排卵时间和自然妊娠时间比较,其差异均无统计学意义(均P>0.05)。子宫动脉栓塞术后半年就可以怀孕,肌瘤切除至少2年才能怀孕,而且手术切除后妊娠,有子宫破裂的风险。结论子宫动脉栓塞术对卵巢功能和生殖内分泌功能影响较小。

Objective To compare the effects of uterine artery embolization and hysteromyomectomy on uterine volume,ovarian function and reproductive endocrine function in patients with hysteromyoma.Methods 300 patients with uterine fibroids were divided into observation group(n=159)and control group(n=141)according to the operation method.The control group underwent laparoscopic myomectomy,and the observation group underwent uterine artery embolization.The operation-related indicators and clinical symptoms were compared between the two groups.The hormone levels were measured by automatic immunoluminescence analyzer.The menstrual recovery time,menstrual cycle,ovulation recovery time and natural pregnancy time were investigated.Results Compared with the control group,the bleeding volume,operation time and hospitalization time in the observation group were reduced(all P<0.05).The incidence of postoperative infection of the observation group was lower than that of the control group(P<0.05).There was no significant difference in uterine volume between the two groups before the operation(P>0.05).After the operation,the uterine volume of patients in the two groups was smaller than that before the operation,and that in the observation group was larger than that in the control group.The difference was statistically significant(P<0.05).Three months after the operation,FSH and LH levels in the two groups were higher than those before operation,E2 levels were lower than those before operation,and FSH and LH levels of the observation group were lower than those of the control group,E2 levels were higher than those of the control group(P<0.05).There were no significant differences in menstrual recovery time,menstrual cycle,ovulation recovery time and natural pregnancy time between the two groups(all P>0.05).Pregnancy can be achieved 6 months after the intervention,or at least 2 years after the hysteromyomectomy,of which there is a risk of uterine ruptcue for postoperative pregnancy.Conclusions Uterine artery embolization has little effect on ovarian function and reproductive endocrine function.