Prospective comparison of laparoscopic uterine artery occlusion plus myomectomy with classic intrafascial supracervical hysterectomy for symptomatic fibroid treatment: differences in post-operative quality-of-life measures.

摘要

OBJECTIVE: Prospective comparison of laparoscopic uterine artery occlusion plus myomectomy (LUAO+M) with classic intrafascial supracervical hysterectomy (CISH) for symptomatic fibroid treatment, regarding differences in post-operative quality-of-life measures. STUDY DESIGN: Three hundred and thirty-two women with symptomatic fibroids who met the inclusion criteria were prospectively randomized into two treatment groups. The study group consisted of 158 women treated with LUAO+M. The control group contained 174 women treated with CISH. Quality of life was measured before surgery and at 2- and 24-month follow-up visits with the World Health Organization Quality of Life-BREF (WHOQOL-BREF), 4-domain questionnaire adapted for Chinese-speaking patients. RESULTS: By age, education, operation time, operative blood loss, and pre-operative WHOQOL-BREF 4-domain and overall scores, both groups were statistically equivalent, demonstrating that the randomization process worked. At 24 months, overall scores were improved for both the study group and control group patients (P<0.01). At 2 months post-surgery, physical domain and social relationship domain scores were statistically higher in the study group than the control group patients (P<0.01). By 24 months, the study group patients' overall scores were statistically higher than the control group scores (P<0.01) because of greater improvements in the physical, psychological, and social relationship domain scores. Only in the environmental domain were the study group and the control group scores statistically equivalent. At 24-month follow-up, the study group patients had a fibroid recurrence rate of only 2.53%-low by historical standards. CONCLUSION: At 24-month follow-up, overall WHOQOL-BREF scores were statistically improved for the study group and control group patients. At the same statistical level, however, women in the study group had greater overall improvement than women in the control group because of higher scores in three of the four questionnaire domains. Women treated with LUAO+M have a very low fibroid recurrence rate at 24 months.