微创医学

目的探讨高强度聚焦超声消融与腹腔镜手术治疗子宫肌瘤的临床疗效及其对卵巢储备功能的影响。方法选择106例子宫肌瘤患者为研究对象，按照随机数字表法将其分为A组、B组，各53例。A组接受高强度聚焦超声消融治疗，B组接受腹腔镜手术治疗。观察两组手术治疗效果，记录两组围术期相关指标，对比两组术前及术后3个月的卵巢储备功能［促卵泡激素（FSH）、黄体生成素（LH）及雌二醇（E2）］水平、子宫内膜厚度及子宫内膜容积，随访并统计两组术后1年不良妊娠结局发生情况。结果两组患者的总有效率比较，差异无统计学意义（P＞0.05）。A组患者的手术时间、住院时间均短于B组，术中出血量少于B组（均P＜0.05）。术后，两组患者的子宫内膜厚度、子宫内膜容积均大于术前，且A组大于B组（均P＜0.05）。术后，B组患者的E2水平上升，A组患者的E2水平下降，B组患者的FSH、LH水平均上升（均P＜0.05），而A组患者手术前后的FSH、LH水平差异均无统计学意义（均P＞0.05）；术后，A组患者的FSH、LH及E2水平均低于B组（均P＜0.05）。两组患者的不良妊娠结局发生率比较，差异无统计学意义（P＞0.05）。结论高强度聚焦超声消融与腹腔镜手术治疗子宫肌瘤均获得较佳效果，但与腹腔镜手术相比，高强度聚焦超声消融对子宫肌瘤患者的卵巢储备功能影响更小，且可改善子宫内膜厚度及子宫内膜容积。

ObjectiveTo investigate the clinical efficacy of high-intensity focused ultrasound ablation and operative laparoscopy in the treatment of uterus myoma and its influence on ovarian reserve function. MethodsA total of 106 patients with uterus myoma were selected and divided into group A and group B according to the random number table method, with 53 cases in each group. Group A received high-intensity focused ultrasound ablation, while group B received operative laparoscopy. The surgical treatment effect of the two groups were observed, the perioperative related indicators of the two groups were recorded. The ovarian reserve function ［follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2)］ levels, endometrial thickness and endometrial volume of the two groups before and 3 months after the operation were compared. All patients were followed up after the operation for 1 year, during which the incidence of the adverse pregnancy outcome was counted. ResultsThere was no statistically significant difference in the total effective rate between the two groups (P＞0.05). The operation time and hospital stay of patients in group A were shorter than those in group B, and the amount of intraoperative bleeding was less than that in group B (all P＜0.05). After the operation, the endometrial thickness and endometrial volume were greater in both groups than those before operation, and they were greater in group A than in group B (all P＜0.05). After the operation, the E2 level increased in group B and decreased in group A, and both the FSH and LH levels increased in group B (all P＜0.05); but there were no significant differences in the FSH and LH levels in group A before and after the operation (all P＞0.05). After the operation, group A had lower FSH, LH and E2 levels as compared with group B (all P＜0.05). The incidence of adverse pregnancy outcomes showed no statistically significant difference between the two groups (P＞0.05). ConclusionHigh-intensity focused ultrasound ablation and operative laparoscopy both can achieve good results in the treatment of uterus myoma. However, compared with operative laparoscopy, high-intensity focused ultrasound ablation has less impact on the ovarian reserve function in patients with uterus myoma, and can improve the thickness and volume of the endometrium.