腹腔镜子宫肌瘤剔除术治疗子宫肌瘤的临床治疗效果观察

腹腔镜子宫肌瘤剔除术治疗子宫肌瘤的临床治疗效果观察

赖迎春

通江县妇幼保健院

[摘要]目的：分析腹腔镜子宫肌瘤剔除术治疗子宫肌瘤的临床疗效。方法：选取我院2020年3月～2022年9月收治的子宫肌瘤患者128例作为研究对象，患者随机分为实验组和对照组，对照组采取传统开腹治疗，实验组采取腹腔镜子宫肌瘤剔除术，对比两组患者应激激素水平、卵巢功能和炎性因子的改善情况。结果：实验组患者治疗的手术时间、手术中出血量、肛门排气、平均住院时间均低于对照组，两组患者的手术治疗指标对比有一定差异，P〈0.05统计学有意义。两组患者手术前的COR和NE水平对比无较大差异，实验组患者手术后的COR和NE水平低于对照组，两组患者术后应激激素水平对比具有一定差异，P〈0.05统计学有意义。两组患者手术前的LH、FSH以及E2等卵巢功能对比无较大差异，实验组治疗后的LH、FSH低于对照组，E2指标高于对照组，两组患者的卵巢功能对比有差异，P〈0.05统计学有意义。结论：腹腔镜下子宫肌瘤剔除术用于治疗子宫肌瘤的效果较好，同时对改善患者的激素应激水平、改善卵巢功能有积极的影响，能够改善患者预后，提高患者术后的生活质量。

关键词：腹腔镜子宫肌瘤剔除术；子宫肌瘤；治疗效果

Clinical observation of laparoscopic myomectomy in the treatment of hysteromyoma

Lai Yingchun

Tongjiang maternal and Child Health Hospital

To analyze the clinical effect of laparoscopic myomectomy on hysteromyoma. Methods: 128 patients with hysteromyoma admitted to our hospital from March 2020 to September 2022 were selected as the study objects. The patients were randomly pided into the experimental group and the control group. The control group was treated with traditional laparotomy, and the experimental group was treated with laparoscopic hysteromyomectomy. The improvement of stress hormone level, ovarian function and inflammatory factors in the two groups were compared.Results: The operation time, the amount of bleeding during the operation, the anal exhaust and the average hospitalization time of the patients in the experimental group were lower than those in the control group. There was a certain difference between the two groups in the comparison of surgical treatment indicators, P. There was no significant difference between the two groups in the level of COR and NE before surgery. The level of COR and NE after surgery in the experimental group was lower than that in the control group. There was a certain difference between the two groups in the level of stress hormones after surgery, P<0.05, which was statistically significant. There was no significant difference between the two groups in comparison of ovarian functions such as LH, FSH and E2 before surgery. After treatment, LH, FSH in the experimental group were lower than those in the control group, and E2 indicators were higher than those in the control group. There was a significant difference between the two groups in comparison of ovarian functions, P<0.05. Conclusion: Laparoscopic myomectomy has a good effect in the treatment of uterine fibroids, and has a positive impact on improving the hormone stress level and ovarian function of patients. It can improve the prognosis of patients and improve the quality of life of patients after surgery.

Key words: laparoscopic myomectomy; fibroid; treatment effect

子宫肌瘤作为女性常见疾病，发病率在20%左右，多发于30～60岁的女性。患者子宫肌瘤中的激素受体表达量相比正常子宫组织受体的表达量更高，激素水平与患者内分泌失调情况有密切关系。

1资料和方法

1.1一般资料  选取我院2020年3月～2022年9月收治的子宫肌瘤患者128例作为研究对象，患者随机分为实验组和对照组，两组患者各有64例。实验组患者平均年龄为（42.14±3.32）岁，对照组患者平均年龄为（41.18±3.26）岁。纳入标准：患者确诊为子宫肌瘤、未采取任何激素类药物治疗、符合麻醉适应证。排除标准：凝血功能障碍、恶性肿瘤、子宫内膜异位症、卵巢囊肿患者均不纳入本文实验。

1.2方法

1.2.1对照组  对照组采取开腹手术治疗，为患者进行全身麻醉，在腹部正中线做手术切口，观察子宫肌瘤的大小、数量、直径等，阻断子宫肌瘤的供血，剔除病灶。若是肌瘤体积较大，则要在浆肌层注射缩宫素，加快子宫的收缩，从而更好的将肌瘤剔除[1]。

1.2.2实验组  实验组采取腹腔镜子宫肌瘤剔除术。患者取全身麻醉，在脐轮上缘1cm的位置作横向切口，建立气腹。穿刺套管置入腹腔镜中，在左右下腹的位置作3个小孔，置入腹腔镜观察子宫肌瘤的数量、生长位置等，根据肌瘤的位置选择合适的剔除方法。浆膜下肌瘤患者在置入腹腔镜后，要在肌瘤蒂部用套扎线圈将肌瘤套扎，采用电凝止血。肌壁间肌瘤患者，置入腹腔镜后注射缩宫素，用单极电钩将子宫肌层切开到肌瘤包膜层，将肌瘤结节剥离，将其旋转牵拉到彻底分离，采用电凝止血[2]。

1.3统计学方法  采用SPSS22.0统计学软件分析实验结果，治疗评估指标采用t检验，用（x±s）表示。两组患者手术治疗效果对比具有差异，P〈0.05统计学有意义。

2结果

2.1两组患者手术指标对比  实验组患者治疗的手术时间、手术中出血量、肛门排气、平均住院时间均低于对照组，两组患者的手术治疗指标对比有一定差异，P〈0.05统计学有意义。见表1。

表1  两组患者手术指标对比

2.2两组患者应激激素水平对比  两组患者手术前的COR和NE水平对比无较大差异，实验组患者手术后的COR和NE水平低于对照组，两组患者术后应激激素水平对比具有一定差异，P〈0.05统计学有意义。见表2。

表2  两组患者应激激素水平对比

2.3两组患者卵巢功能对比  两组患者手术前的LH、FSH以及E2等卵巢功能对比无较大差异，实验组治疗后的LH、FSH低于对照组，E2指标高于对照组，两组患者的卵巢功能对比有差异，P〈0.05统计学有意义。见表3。

表3  两组患者卵巢功能对比

3讨论

    子宫肌瘤一般采用药物、手术治疗，具有极好的治疗效果，手术主要类型为全子宫切除术、子宫肌瘤剔除术，子宫肌瘤剔除术具有保留患者生育能力的优势，手术切除是子宫肌瘤的主要治疗方法，腹腔镜的创伤小、住院时间少、术后恢复快，因此成为了临床治疗的主要手段[3]。腹腔镜下子宫肌瘤剔除术用于治疗子宫肌瘤的效果较好，同时对改善患者的激素应激水平、改善卵巢功能有积极的影响，能够改善患者预后，提高患者术后的生活质量。

参考文献：

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[2] 金燕,汪锋,殷明顺. 腹腔镜子宫肌瘤剔除术治疗子宫肌瘤的疗效探讨[J]. 当代医学,2020,26(25):154-155.

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