腹腔镜与腹式全子宫切除术治疗子宫肌瘤的效果比较

罗莉 孙芳 罗世芳 江福灿

[摘要]目的 探究腹腔鏡与腹式全子宫切除术治疗子宫肌瘤疗效及对激素水平、盆底功能的影响。方法 选取2014年2月～2017年6月我院收治的64例子宫肌瘤患者为研究对象，采用随机数字表法将其分为腹腔镜全子宫切除术（TLH）组（观察组）和腹式全子宫切除术（TAH）组（对照组），每组32例。观察组给予TLH术式治疗，对照组则予以TAH术式治疗；记录两组围术期指标（手术时间、术中出血量、术后疼痛时间、住院时间）、住院期间并发症发生情况、术后3个月时盆底功能{盆底肌力、漏尿量、性功能[女性性功能指数（FSFI）]}情况差异，并比较两组术前及术后3个月激素[促卵泡激素（FSH）、黄体生成素（LH）]水平差异。结果 观察组患者手术时间长于对照组（P<0.05），但术中出血量少于对照组（P<0.05），术后疼痛时间及住院时间均短于对照组，差异均有统计学意义（P<0.05）。观察组患者住院期间并发症总发生率显著低于对照组，差异有统计学意义（P<0.05）。术后3个月时，观察组患者的盆底肌力及FSFI评分均高于对照组（P<0.05），漏尿量低于对照组，差异均有统计学意义（P<0.05）。两组患者术前FSH、LH水平的比较，差异无统计学意义（P>0.05）；术后3个月时，两组FSH、LH水平均较术前升高，且观察组低于对照组，差异均有统计学意义（P<0.05）。结论 TLH术式对子宫肌瘤患者术后卵巢功能及盆底功能影响较TAH术式小，且并发症较少，手术效果显著，利于患者术后恢复。

[关键词]腹腔镜全子宫切除术；腹式全子宫切除术；子宫肌瘤；激素水平；盆底功能

[中图分类号] R737 [文献标识码] A [文章编号] 1674-4721（2018）5（a）-0104-03

[Abstract]Objective To investigate the efficacy of total laparoscopic and total abdominal hysterectomy in the treatment of uterine fibroids and its effects on hormone levels and pelvic floor function.Methods From February 2014 to June 2017，64 patients with hysteromyoma were selected and randomly divided into two groups：laparoscopic total hysterectomy （TLH） group （observation group） and abdominal total hysterectomy （TAH） group （control group），32 cases in each group. The observation group was treated with tlh and the control group was treated with TLH. The perioperative indexes（operation time，intraoperative blood loss，postoperative pain time，hospitalization time），complications during hospitalization，pelvic floor function （pelvic floor muscle strength，urine leakage，sexual function [（FSFI）] at 3 months after operation were recorded. the levels of hormone （follicle stimulating hormone （FSH），luteinizing hormone（LH）before operation and 3 months after operation were compared between the two groups.Results The operation time of the observation group was longer than that of the control group （P<0.05），but the intraoperative blood loss was less than that of the control group（P<0.05），the postoperative pain time and hospitalization time of the observation group were shorter than those of the control group，the differences were statistically significant（P<0.05）.The total incidence of complications in the observation group was significantly lower than that in the control group，the difference was statistically significant（P<0.05）.At 3 months after operation，the pelvic floor muscle strength and FSFI score in the observation group were higher than those in the control group，and urine leakage was lower than that in the control group，The differences were statistically significant （P<0.05）.There was no significant difference in FSH and LH levels between the two groups（P>0.05）.At 3 months after operation，FSH and LH levels in the two groups were lower than those in the control group，the differences were statistically significant（P<0.05）.Conclusion The TLH procedure has a smaller effect on postoperative ovarian function and pelvic floor function in patients with uterine fibroids than the TAH procedure，with fewer complications and significant surgical results，which will benefit the patients recovering from surgery.

[Key words]Total laparoscopic hysterectomy；Total abdominal hysterectomy；Uterine fibroids；Hormone levels；Pelvic floor function

子宫肌瘤为妇科常见良性肿瘤，在肿瘤直径增大到一定程度时多需进行子宫切除术治疗，腹腔镜全子宫切除术（TLH）、腹式全子宫切除术（TAH）等为其常用治疗方法，虽然此类手术方法能有效去除肌瘤，但对患者均造成不同程度创伤，影响患者术后生活质量[1]。有学者认为，不同术式全子宫切除术手术效果不一，手术切口较大、术中出血量较多等能造成较大的手术创伤，术中操作不当可引起患者术后性功能或排尿功能障碍，而手术时间过长也可增加患者手术应激反应而延长患者康复时间，这些使子宫肌瘤患者预后情况存在显著差异[2]。……