高香丽，沈金凤

(北京中医医院顺义医院，北京 101300)



三种不同术式对子宫肌瘤患者卵巢储备功能、妊娠结局的影响比较

高香丽，沈金凤

(北京中医医院顺义医院，北京 101300)

目的探讨腹腔镜子宫肌瘤剔除术(LM)、子宫动脉栓塞术(UAE)及射频消融术(RA)对子宫肌瘤患者卵巢储备功能、妊娠结局的影响。方法选取2012年7月至2015年7月在北京中医医院顺义医院采用子宫肌瘤剔除术、射频消融术以及子宫动脉栓塞术3种方法治疗的子宫肌瘤患者349例，根据治疗方式分为LM组187例、UAE组76例，RA组86例，比较3种治疗方式的临床疗效、卵巢储备功能以及妊娠结局。结果RA的手术时间和住院时间最短，同UAE组、LM组比较均有统计学差异(t值分别为9.23、10.13、9.78、10.03，均P<0.05)；临床疗效方面，LM治愈率显著高于RA组、UAE组(χ2值分别为6.04、8.31，均P<0.05)；术后1个月，LM组FSH、FSH/LH、E2均明显升高、而AFC显著降低，同RA组、UAE组比较有显著性差异(t值6.76～9.32，均P<0.05)；RA组、LM组成功妊娠率显著高于UAE组(χ2值分别为7.33，6.36，均P<0.05)，其中RA组顺产率显著高于LM组、UAE组(χ2值分别为10.54、7.73，均P<0.05)；不良妊娠中，UAE组早产率、流产率均高于LM组、RA组(χ2值分别为6.13、6.09、587、5.91，均P<0.05)。结论LM临床治愈率高于RA、UAE，但其术后初期卵巢储备功能略有下降，RA、UAE对卵巢储备功能无明显影响，RA成功妊娠率最高，在临床上值得推广。

腹腔镜子宫肌瘤剔除术；子宫动脉栓塞术；射频消融术；卵巢储备功能

[Abstract]Objective To explore the influence of laparoscopic myomectomy (LM), uterine artery embolization (UAE) and radiofrequency ablation (RA) on ovarian reserve function and pregnancy outcomes of patients with uterine fibroids. Methods From July 2012 to July 2015 patients with uterine fibroids undergoing LM, UAE and RA in Shunyi Hospital of Beijing Chinese Medicine Hospital were divided into LM group, UAE group and RA group according to operation type. Three groups were compared in clinical efficacy, ovarian reserve function and pregnancy outcomes. Results In RA group surgery and hospital stay were shortest, which were statistically different from UAE group and LM group (tvalue was 9.23, 10.13, 9.78 and 10.03, respectively, allP<0.05). In terms of clinical efficacy, curative rate of LM group was significantly higher than RA group and UAE group (χ2value was 6.04 and 8.31, respectively, bothP<0.05). One month after surgery, FSH, FSH/LH and E2increased obviously but AFC declined remarkably in LM group, and they were significantly different from RA group and UAE group (tvalue ranged 6.76-9.32, allP<0.05). Compared with UAE group, RA group and LM group had significantly higher successful pregnancy rate (χ2value was 7.33 and 6.36, respectively, bothP<0.05), but RA group had significantly higher spontaneous abortion rate than LM group and UAE group (χ2value was 10.54 and 7.73, respectively, bothP<0.05). In adverse pregnancy, preterm birth rate and abortion rate were higher in UAE group than in LM group and RA group (χ2value was 6.13, 6.09, 587 and 5.91, respectively, allP<0.05). Conclusion Clinical curative rate of LM is higher than RA and UAE, but ovarian reserve function falls slightly at the beginning period after surgery. RA and UAE have no significant influence on ovarian reserve function. RA obtains highest successful pregnancy rate and is worthy of promotion in clinical practice.

[Keywords]laparoscopic myomectomy (LM); uterine artery embolization (UAE); radiofrequency ablation (RA); ovarian reserve function

子宫肌瘤是育龄期妇女最为常见的生殖系统良性肿瘤，其导致妇女出现不孕症、尿频、异常子宫出血、流产等[1]。治疗子宫肌瘤最为可靠的方法是手术治疗，如子宫全切术、子宫肌瘤剔除术等，但是手术治疗创伤大、尤其是子宫全切术、次切术对患者日后的生活质量有明显影响[2]。近年来，微创手术如子宫动脉栓塞术(uterine artery embolization，UAE)、射频消融术(radiofrequency ablation，RA)等日益受到关注，其对子宫的创伤小。UAE、RA以及腹腔镜子宫肌瘤剔除术(laparoscopic myomectomy，LM)是目前临床治疗子宫肌瘤时，保留子宫的治疗方式。但是其对于患者卵巢储备功能、妊娠结局的影响报道较少。本研究旨在探讨上述3种不同治疗方式对子宫肌瘤患者卵巢储备功能、妊娠结局的影响。……