同期或分期处理子宫纵隔合并子宫肌瘤对生殖内分泌与转归影响  

Effect of simultaneous or staged management of uterine septum complicated with uterine fibroids on reproductive endocrinology and prognosis

作　　者：何巍 刘秀梅 郭西雨 张秋月 HE Wei;LIU Xiumei;GUO Xiyu;ZHANG Qiuyue(Qinhuangdao Maternal and Child Health Hospital,Qinhuangdao 066000,China)

机构地区：[1]秦皇岛市妇幼保健院,河北秦皇岛066000

出　　处：《新医学》2024年第5期360-366,共7页Journal of New Medicine

基　　金：秦皇岛市科学技术研究与发展计划项目(202004A046)。

摘　　要：目的探讨宫腔镜子宫纵隔切除术(TCRS)同期或分期处理子宫肌瘤效果及其对生殖内分泌和转归影响。方法收集87例纵隔子宫伴子宫肌瘤患者的临床资料,根据手术方法不同分为同期组43例和分期组44例。同期组行同期宫腔镜TCRS和子宫肌瘤切除术(TCRM),分期组行分期宫腔镜TCRS和TCRM。比较2组的手术情况、术后子宫肌层愈合情况、子宫内膜及子宫内膜下血流参数[血流指数(FI)、血管化血流指数(VFI)、血管化指数(VI)]、子宫内膜厚度、生殖内分泌指标[雌二醇(E_(2))、黄体生成素(LH)、卵泡刺激素(FSH)]、生殖转归及并发症。结果2组均成功完成手术。同期组的手术时间、下床活动时间、住院时间均短于分期组(P均<0.05);同期组术后1个月子宫肌层愈合患者占比高于分期组(P<0.05);2组术前和术后1、3个月子宫内膜及子宫内膜下血流参数、子宫内膜厚度、生殖内分泌指标比较差异均无统计学意义(P均>0.05);同期组术后6个月妊娠患者占比高于分期组(P<0.05);2组并发症发生率比较差异无统计学意义(P>0.05)。结论TCRS同期处理子宫肌瘤不影响子宫内膜血流动力学、子宫内膜容受性、卵巢储备功能及生殖内分泌功能,且可缩短手术时间、下床活动及住院时间,有利于术后妊娠,具有一定安全性。Objective To evaluate the efficacy of simultaneous or staged management of uterine fibroids by transcervical resection of septum(TCRS),reproductive endocrinology and clinical prognosis.Methods Clinical data of 87 patients with uterine septum complicated with uterine fibroids were collected.All patients were divided into the simultaneous(n=43)and staged groups(n=44)according to different surgical methods.In the simultaneous group,hysteroscopic TCRS and transcervical resection of myoma(TCRM)were performed simultaneously,whereas staged hysteroscopic TCRS and TCRM were conducted in the staged group.Surgical conditions,postoperative myometrial healing,endometrial and subendometrial blood flow parameters(flow index(FI),vascularization flow index(VFI)and vascularization index(VI)),endometrial thickness,reproductive endocrine indexes(luteinizing hormone(LH),follicle stimulating hormone(FSH),estradiol(E_(2))),reproductive outcomes and complications were compared between two groups.Results All patients in both groups completed the surgery successfully.The operation time,time to the first off-bed activity and the length of hospital stay in the simultaneous group were shorter than those in the staged group(all P<0.05).In the simultaneous group,the proportion of patients with myometrial healing at 1 month after surgery was higher than that in the staged group(P<0.05).The differences in subendometrial VFI,FI,VI,endometrial thickness and E2,LH and FSH levels before surgery,1 month and 3 months after surgery were not statistically significant between two groups(all P>0.05).The percentage of patients who were pregnant at postoperative 6 months in the simultaneous group was higher than that in the staged group(P<0.05).The difference in the incidence of complication was not statistically significant between two groups(P>0.05).Conclusions Simultaneous management of uterine fibroids by TCRS does not affect endometrial hemodynamics,endometrial tolerance,ovarian reserve function and reproductive endocrine function.In addition,it can sh

关 键 词：宫腔镜 子宫肌瘤 纵隔子宫 子宫纵隔切除术 子宫肌瘤切除术 妊娠 子宫内膜 

分 类 号：R737.33[医药卫生—肿瘤] R713.4[医药卫生—临床医学]