不同腹腔镜子宫动脉阻断方法对卵巢储备功能的影响

目的：研究腹腔镜下不同子宫动脉阻断法对子宫肌瘤患者卵巢储备功能的影响。方法选择2011年7月至2014年1月在我院妇产科就诊的子宫肌瘤患者120例，根据手术方式分三组，每组40例。A组患者行腹腔镜子宫动脉永久阻断+子宫肌瘤剥除术(PAB+LM)；B组患者行腹腔镜子宫动脉临时阻断+子宫肌瘤剥除术(TAL+LM)；C组患者行腹腔镜子宫肌瘤剥除术(LM)。比较三组患者术前、术后3个月、12个月及24个月的卵泡早期雌二醇(E2)、促卵泡生成素(FSH)、抗苗勒管激素(AMH)水平及窦状卵泡数(AFC)数，并记录潮热等更年期症状，进行卵巢功能评定。结果 A组患者术后3个月的E2水平为(70.46±12.30) mg/L，较术前的(79.56±10.10) mg/L明显下降，FSH水平为(6.81±1.56) IU/L，较术前的(5.90±1.06) IU/L明显升高，差异均有统计学意义(P<0.05)；而术后12个月E2(80.26±11.10) mg/L，FSH (6.25±1.57) IU/L]及24个月E2(79.66±12.15) mg/L，FSH (5.89±1.34) IU/L]分别与术前比较差异均无统计学意义(P>0.05)；B、C组各激素及A组AMH在不同时点比较差异均无统计学意义(P>0.05)。三组间比较，术后3个月E2水平，B组和C组分别为(79.14±12.25) mg/L和(79.24±9.23) mg/L，均高于A组的(70.46±12.30) mg/L，差异均有统计学意义(P<0.05)，其余激素三组间比较差异均无统计学意义(P>0.05)。A、B两组术前的AFC分别为(8.25±1.43)个和(8.24±1.38)个，术后3个月均降低，分别为(7.08±1.92)个和(7.11±1.56)个，差异均有统计学意义(P<0.05)，但两组在术后12个月均恢复正常；C组手术前后比较差异无统计学意义(P>0.05)。三组患者术前、术后均未出现潮热等症状，卵巢储备功能在术前术后无明显变化。结论在腹腔镜子宫肌瘤剥除术中联合TAL不影响卵巢功能，而联合PAB对卵巢功能的影响短暂可逆，不增加绝经期提前的风险。

Effect of uterine artery occlusion during laparoscopic myomectomy on ovarian reserve function

Objective To explore the effect of transient and permanent uterine artery occlusion during laparo-scopic myomectomy on the postoperative ovarian reserve function. Methods One hundred and twenty patients with symptomatic myomas were divided into three groups with 40 patients in each. Group A underwent laparoscopic myomec-tomy combined with permanent uterine artery occlusion, and group B received laparoscopic myomectomy combined with transient uterine artery occlusion. Group C underwent laparoscopic myomectomy only. The ovarian function, follicle-stim-ulating hormone (FSH), estradiol (E2), anti-mullerian hormone (AMH), antral follicle count (AFC) and climacteric symp-toms (such as hot flashes) of three groups were compared respectively. Results In group A, the level of E2 at 3 months af-ter operation was significantly decreased, while the level of FSH was significantly increased, (70.46 ± 12.30) mg/L vs (79.56 ± 10.10) mg/L, (6.81 ± 1.56) IU/L vs (5.90 ± 1.06) IU/L, both P<0.05. Whereas, the results at 12 months (E2 (80.26 ± 11.10) mg/L, FSH (6.25 ± 1.57) IU/L) and 24 months after operation (E2 (79.66 ± 12.15) mg/L, FSH (5.89 ± 1.34) IU/L) showed no statistically significantly difference with the preoperative level (P>0.05). No significant changes were detect-ed in the level of AMH at all the time points in group A. In group B and C, no significant difference was found in the lev-el of any reproductive hormones among at all time points. Group A showed significantly lower level of E2 than group B and C at 3 months after operation, (70.46±12.30) mg/L vs (79.14±12.25) mg/L, (79.24±9.23) mg/L, P<0.05), with no sig-nificant difference in other hormones among the three groups. The AFC of group A, B were (8.25±1.43) and (8.24±1.38) before operation, which were reduced to (7.08 ± 1.92) and (7.11 ± 1.56), with statistically significant difference (P<0.05), and then return to normal 12 months after operation. There was no significant difference in AFC of group C before and after operation. The patients were followed up for two years, during which the ovarian reserve function was not signifi-cantly different among the groups (P>0.05), with no hot flashes found. Conclusion The effect of permanent uterine artery occlusion during laparoscopic myomectomy on ovarian function is transient and reversible. There is no signifi-cant effect of transient uterine artery occlusion on ovarian function.