摘要
目的探讨阴式子宫肌瘤剔除术与腹腔镜下子宫肌瘤剔除术治疗对患者卵巢功能和血清性激素水平的影响,为临床治疗提供参考依据。方法选取2014年9月-2016年11月在华北理工大学附属医院接受手术治疗的137例子宫肌瘤患者作为研究对象,对其临床资料进行回顾性分析,根据手术方式的不同将所有患者分为腹腔镜组(63例)和阴式组(74例)。比较两组患者手术情况相关指标,两组患者手术前、术后1个月和术后6个月的血清雌二醇(E2)、卵泡刺激素(FSH)、黄体生成素(LH)等激素水平变化情况,并对患者卵巢功能进行评价和比较;术后对患者进行随访,记录并比较两组患者子宫肌瘤复发和恢复正常月经情况。结果阴式组手术时间和术中出血量低于腹腔镜组(P<0.05),而两组剔除单个肌瘤的重量、术后排气时间、住院时间及术后并发症发生率比较差异无统计学意义(P>0.05)。术后1个月,两组患者FSH、LH水平均高于术前(P<0.05),E2水平低于术前(P<0.05);术后6个月,两组患者E2、FSH水平和腹腔镜组LH水平与手术前相比差异无统计学意义(P>0.05),而阴式组LH水平仍高于术前(P<0.05)。两组间血清性激素水平比较,差异无统计学意义(P>0.05)。随访发现,两组复发率和术后1个月恢复正常月经比例比较差异无统计学意义(P>0.05)。结论阴式子宫肌瘤剔除术和腹腔镜下子宫肌瘤剔除术治疗子宫肌瘤具有腹部无切口、创伤小、住院时间短、术后恢复快、并发症少、复发率低等优势,虽然术后均会对患者的卵巢功能和血清性激素水平产生影响,但影响均较小,术后可快速恢复。两种手术方式各有其特点和适应证,临床应用时需根据患者的具体情况进行选择,以达到最佳的治疗效果。
Objective To explore the effect of transvaginal myomectomy and laparoscopic myomectomy on ovarian function and serum sex hormone levels,provide a reference basis for clinical treatment. Methods From September 2014 to November 2016,137 uterine fibroids patients treated by surgery in Affiliated Hospital of North China University of Technology were selected,the clinical data was analyzed retrospectively. All the patients were divided into laparoscopic surgery group（ 63 patients） and transvaginal surgery group（ 74 patients）.The related indexes of surgery,the changes of serum estradiol（ E2）,follicle-stimulating hormone（ FSH）,and luteinizing hormone（ LH）before surgery,at one and six months after surgery in the two groups were compared. The ovarian function was evaluated and compared. The patients were followed up after surgery. The recurrence rates of uterine fibroids and recovery of normal menstruation in the two groups were recorded and compared. Results The operation time and the amount of blood loss during operation in transvaginal surgery group were statistically significantly lower than those in laparoscopic surgery group（ P〈0. 05）. There was no statistically significant difference in the weight of single myoma,postoperative exhausting time,hospitalization time,and the incidence rate of postoperative complications between the two groups（ P〈0. 05）. At one month after surgery,the levels of follicle-stimulating hormone（ FSH） and luteinizing hormone（ LH） in the two groups were statistically significantly higher than those before surgery（ P〈0. 05）,the levels of estradiol in the two groups were statistically significantly lower than those before surgery（ P〈0. 05）. There was no statistically significant difference in the levels of estradiol and FSH between before surgery and at six months after surgery in the two groups（ P〈0. 05）. There was no statistically significant difference in the level of LH between before surgery and at six months after surgery in laparoscopic surgery group（ P〈0. 05）. The level of LH at six months after surgery in transvaginal surgery group was statistically significantly higher than that before surgery（ P〈0. 05）. There was no statistically significant difference in the levels of serum sex hormones between the two groups（ P〉0. 05）. There was no statistically significant difference in the recurrence rate of uterine fibroids and the proportion of patients with normal menstruation within one month after surgery between the two groups（ P〉0. 05）. Conclusion Transvaginal myomectomy and laparoscopic myomectomy have the advantages of non-abdominal incision,less trauma,short hospitalization time,rapid postoperative recovery,few complications,low recurrence rate in treatment of uterine fibroids. Although the two operations have impact on ovarian function and the levels of sex hormone in serum after surgery,but the effect is relatively small,postoperative patients can recover quickly. The two kinds of surgical methods have their own characteristics and indications,which should be selected according to the specific circumstances of patients to achieve the best therapeutic effect.
作者
白洁
曹佳宇
冼常岭
何艳舫
BAI Jie;CAO Jia-Yu;XIAN Chang-Ling(Department of Obstetrics and Gynecology, Affiliated Hospital of North China University of Technology, Tangshan, Hebei 063000, Chin)
出处
《中国妇幼保健》
CAS
2018年第12期2846-2849,共4页
Maternal and Child Health Care of China
基金
河北省医学科学研究重点课题计划项目(20160723)
