腹腔镜下改良经脐单孔与多孔手术治疗子宫肌瘤的疗效及对卵巢储备功能、术后复发的影响

Efficacy of modified transumbilical single-port and multi-port laparoscopic surgeries for uterine fibroids and their effects on ovarian reserve function and postoperative recurrence

摘要:

目的 分析腹腔镜下改良经脐单孔与多孔手术治疗子宫肌瘤的疗效及对卵巢储备功能、术后复发的影响。方法 选取2022年4月—2024年12月扬州大学医学院附属淮安市妇幼保健院收治的81例子宫肌瘤患者，按不同手术方法分为对照组（41例）和观察组（40例）。对照组行腹腔镜下多孔手术，观察组行腹腔镜下改良经脐单孔手术。比较两组手术相关指标、卵巢储备功能、性激素水平、性功能、痛经情况、子宫体积、子宫内膜容受性、并发症、术后6个月复发情况。结果 观察组手术时间长于对照组（P <0.05），术中出血量少于对照组（P <0.05），肛门排气时间、首次下床活动时间均短于对照组（P <0.05），术后24 h引流量和子宫肌瘤残留率均低于对照组（P <0.05）。观察组治疗前后抗缪勒管激素、窦卵泡计数、卵巢体积、雌二醇水平、女性性功能指数、视觉模拟评分法评分、子宫体积、子宫内膜搏动指数、阻力指数、收缩期峰值流速的差值均大于对照组（P <0.05）。观察组并发症总发生率低于对照组（P <0.05）。随访6个月，观察组复发率低于对照组（P <0.05）。结论 与腹腔镜下多孔手术比较，腹腔镜下改良经脐单孔手术治疗子宫肌瘤效果更好，患者卵巢储备功能恢复更佳，且术后6个月复发率较低。

Abstract:

Objective To analyze the efficacy of modified transumbilical single-port and multi-port laparoscopic surgeries for uterine fibroids, and their effects on ovarian reserve function and postoperative recurrence.Methods Eighty-one patients with uterine fibroids admitted to Huai'an Maternal and Child Health Hospital Affiliated to the Medical College of Yangzhou University between April 2022 and December 2024 were enrolled. They were divided into two groups based on surgical approaches. The control group underwent multi-port laparoscopic surgery (n = 41), while the observation group underwent modified transumbilical single-port laparoscopic surgery (n = 40). The two groups were compared regarding surgery-related parameters, ovarian reserve function, sex hormone levels, sexual function, dysmenorrhea, uterine volume, endometrial receptivity, complications, and recurrence rates at 6 months postoperatively.Results The observation group exhibited longer operative duration than the control group (P < 0.05). However, patients in the observation group exhibited reduced intraoperative blood loss, shorter time to first flatus and ambulation, lower 24-hour postoperative drainage volume, and a decreased residual rate of uterine fibroids compared with the control group (P < 0.05). The changes in anti-Müllerian hormone levels, antral follicle count, ovarian volume, estradiol levels, Female Sexual Function Index scores, visual analog scale scores, uterine volume, uterine artery pulsatility index, resistance index, and peak systolic velocity before and after treatment were all greater in the observation group than in the control group (P < 0.05). The overall incidence of complications in the observation group was higher than that in the control group (P < 0.05). At 6-month follow-up, the recurrence rate was lower in the observation group than in the control group (P < 0.05).Conclusion Compared with multi-port laparoscopic surgery, modified transumbilical single-port laparoscopic surgery yields superior outcomes in patients with uterine fibroids, with better restoration of ovarian reserve function and lower recurrence rates at 6 months postoperatively.