不同方法治疗子宫肌瘤卵巢功能变化的研究

摘要

目的:探讨射频消融(RFA)术、腹腔镜核除术及子宫全切术治疗子宫肌瘤对卵巢功能的影响及疗效.方法:选取在医院就诊的60例子宫肌瘤患者,根据治疗方法的不同将其分为RFA组(20例),腹腔镜组(20例)和子宫切除组(20例).对3组患者术前、术后3个月和6个月的血清卵泡刺激素(FSH)和雌二醇(E2)的水平进行测定,比较分析不同治疗方法对卵巢功能的影响及疗效.结果:3组患者均一次手术成功,术后3个月RFA组、腹腔镜组和子宫切除组总有效率分别为98%(19/20)、98%(19/20)和100%(20/20);术后6个月总有效率分别为90%(18/20)、98%(19/20)和100%(20/20).3组术后3个月、6个月疗效比较差异均无统计学意义(F=5.350,F=8.319;P>0.05).术前3组患者激素水平均异常,术后3个月,RFA组激素水平正常占60%(12/20),腹腔镜组患者激素水平正常占50%(10/20),RFA组和腹腔镜组激素水平与术前比较,差异均有统计学意义(t=7.938,t=8.362;P<0.05).子宫切除组所有患者术后3个月血清FSH升高,E2降低,与术前比较差异无统计学意义(t=2.017,t=3.887;P>0.05).术后6个月,RFA组激素水平正常占70%(14/20),腹腔镜组患者激素水平正常占65%(13/20),与术前比较,FSH降低,E2升高,差异均有统计学意义(t=10.918,t=11.218;P<0.05).结论:采用3种方法治疗子宫肌瘤均疗效显著,但子宫全切术后患者卵巢功能衰退,RFA术和腹腔镜下肌瘤核除术可以使部分患者卵巢功能得到改善.%Objective:To explore the impact and curative effect of radiofrequency ablation (RFA), laparoscopic surgery and total hysterectomy for ovarian function in the treatment of uterine fibroids.Methods: 60 patients with uterine fibroids were divided into RFA group (20 cases) and laparoscope group (20 cases) and panhysterectomy group (20 cases) as different therapeutic method. The serum follicle stimulating hormone (FSH) and estradiol (E2) of three groups in preoperative, postoperative 3th month and postoperative 6th month were detected, respectively. The influence and curative effect of different therapeutic method on ovarian function were compared and analyzed. Results: All of operations of three groups were successful at the first time, and the total effective rate of the three groups were 98% (19/20), 98% (19/20), 100% (20/20) at postoperative 3th months, respectively. And the total effective rate of the three groups were 90% (18/20), 98% (19/20), 100% (20/20) at postoperative 6th months, respectively. There was no significant difference between the 3th month and 6th month (F=5.350,F=8.319,P>0.05). The hormonal level of patients in three groups were abnormal at preoperative period, while at postoperative 3th month, the normal hormonal levels were, respectively, 60% (12/20) in RFA group, 50%(10/20) in laparoscope group. And the differences of each group between pre and post operation were significantly (t=7.938,t=8.362,P<0.05), respectively. And at the postoperative 3th month, the serum FSH and E2 of pan-hysterectomy group were no, respectively, significant higher and lower than that of preoperative results (t=2.017,P>0.05). At the postoperative 6th month, the normal hormonal level were, respectively, 70% (14/20) in RFA group, 65% (13/20) in laparoscope group. And the FSH and E2 of these groups were significantly higher and lower than that of pre-operation (t=10.918, t=11.218,P<0.05).Conclusion: All of the three methods has significant curative effect in the treatment of uterine fibroids, and the ovarian function is improved by using RFA and laparoscope while it is recession by using pan-hysterectomy.