探讨腹腔镜下子宫动脉阻断术联合子宫肌瘤切除术(LUAO-M)治疗子宫肌瘤的临床疗效。

选择2018年7月至2021年12月张家口市妇幼保健院收治的120例子宫肌瘤患者为研究对象。根据患者接受手术方式不同，将其分为LUAO-M组(n＝60)和腹腔镜下子宫肌瘤切除术(LM)组(n＝60)。回顾性分析2组患者术前、术后7 d及21 d时的血清促卵泡生成素(FSH)，黄体生成素(LH)及雌二醇水平；以及术后24 h与72 h时的血清肿瘤坏死因子(TNF)-α、白细胞介素(IL)-1和IL-6水平。对2组患者术后随访1年，随访内容包括月经过多缓解率、闭经率、肌瘤复发率、子宫体积及1年无进展生存(PFS)率。本研究遵循的程序符合张家口市妇幼保健院医学伦理委员会要求，并获得医院伦理委员会批准(批号：第2023-012号)。所有患者对诊疗过程知情并签署临床研究知情同意书。

① 2组患者年龄，肌瘤直径、数目及类别构成比比较，差异均无统计学意义(P>0.05)。② LUAO-M组患者的术中出血量、手术时间、术后肛门排气时间、术后住院时间，均少于或短于LM组，并且差异均有统计学意义(t＝6.02、3.10、5.86、2.76，P均<0.05)。③对2组患者术后7 d及21 d时的FSH、LH和雌二醇水平进行重复测量资料方差分析显示，不同治疗措施与时间因素的交互效应，差异均有统计学意义(F_{治疗×时间}＝9.33、50.63、47.32，P_{治疗×时间}均<0.001)。④对2组患者术前、术后24 h及72 h时的TNF-α、IL-1和IL-6水平进行重复测量资料方差分析显示，不同治疗措施与时间因素的交互效应，差异均有统计学意义(F_{治疗×时间}＝3.35、10.62、16.53，P_{治疗×时间}均<0.001)。⑤ LUAO-M组患者术后并发症总发生率低于LM组，并且差异有统计学意义(χ²＝5.07，P＝0.024)。

LUAO-M治疗子宫肌瘤，有助于提高患者生存率、降低并发症总发生率，保护患者卵巢功能。

To explore clinical efficacy of laparoscopic uterine artery occlusion combined with myomectomy (LUAO-M) for the treatment of uterine fibroids.

A total of 120 patients with uterine fibroids admitted to the Department of Obstetrics and Gynecology at Zhangjiakou Maternal and Child Health Hospital from July 2018 to December 2021 were selected into this study. According to different surgical methods, they were randomly divided into LUAO-M group (n=60) and laparoscopic myomectomy (LM) group (n=60). Retrospective analysis was performed on the serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol levels of the two groups of patients before and after surgery at 7 days and 21 days; as well as the serum levels of tumor necrosis factor (TNF)-α, interleukin (IL)-1, and IL-6 before and after surgery at 24 and 72 hours. The two groups of patients were followed up for one year after surgery, and the follow-up content included the alleviation rate of menorrhagia, amenorrhea, fibroid recurrence, uterine volume, and 1-year progression-free survival (PFS) rate. The procedures followed in this study were in accordance with the requirements of the Medical Ethics Committee of Zhangjiakou Maternal and Child Health Hospital and were approved by the hospital′s ethics committee (Approval No. 2023-012). Informed consents were obtained from all participants.

① There was no statistically significant difference in age, fibroid size, number of fibroids, and the composition ratio of fibroid categories between the two groups (P>0.05). ② The intraoperative blood loss, operation time, time to postoperative anal passage gas, and postoperative hospital stay of the LUAO-M group were all less than or shorter than those of the LM group, and the differences were statistically significant (t=6.02, 3.10, 5.86, 2.76; all P<0.05). ③ Repeated measures analysis of variance of FSH, LH, and estradiol levels before and after surgery at 7 days and 21 days for the two groups of patients showed that the interactive effect of different treatment measures and time factors was statistically significant (F_{treatment×time}=9.33, 50.63, 47.32; all P_{treatment×time}<0.001). ④ Repeated measures analysis of variance of TNF-α, IL-1, and IL-6 levels before and after surgery at 24 hours and 72 hours for the two groups of patients showed that the interactive effect of different treatment measures and time factors was statistically significant (F_{treatment×time}=3.35, 10.62, 16.53; all P_{treatment×time}<0.001). ⑤ The overall incidence rate of postoperative complications in the LUAO-M group was lower than that in the LM group, and the difference between the groups was statistically significant (χ²=5.07, P=0.024).

LUAO-M treatment for uterine fibroids helps to improve patient survival rates, reduce the incidence of complications, and protect ovarian function.