Clinical efficacy of laparoscopic uterine artery ligation combined with myomectomy for the treatment of uterine fibroids

doi:10.3877/cma.j.issn.1673-5250.2024.02.016

Objective

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

Methods

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.

Results

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).

Conclusions

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

Key words: Uterine fibroids, Laparoscopic uterine artery blockade combined with myomectomy, Laparoscopic myomectomy, Ovarian function, Fibroids recur, Female

表1 2组子宫肌瘤患者的一般临床资料比较(

±s)

组别	例数	年龄(岁，±s)	肌瘤直径(cm，±s)	肌瘤数目(个，±s)	肌瘤类别[例数(%)]
组别	例数	年龄(岁，±s)	肌瘤直径(cm，±s)	肌瘤数目(个，±s)	肌壁间肌瘤	浆膜下肌瘤
LUAO-M组	60	38.9±5.4	6.2±1.0	3.6±1.3	33(55.0)	27(45.0)
LM组	60	38.7±5.4	6.1±1.2	3.6±1.2	32(53.3)	28(46.7)
统计量		t＝0.25	t＝0.31	t＝0.09	χ²＝0.03
P值		0.710	0.680	0.811	0.862

表1 2组子宫肌瘤患者的一般临床资料比较(

±s)

组别	例数	年龄(岁，±s)	肌瘤直径(cm，±s)	肌瘤数目(个，±s)	肌瘤类别[例数(%)]
组别	例数	年龄(岁，±s)	肌瘤直径(cm，±s)	肌瘤数目(个，±s)	肌壁间肌瘤	浆膜下肌瘤
LUAO-M组	60	38.9±5.4	6.2±1.0	3.6±1.3	33(55.0)	27(45.0)
LM组	60	38.7±5.4	6.1±1.2	3.6±1.2	32(53.3)	28(46.7)
统计量		t＝0.25	t＝0.31	t＝0.09	χ²＝0.03
P值		0.710	0.680	0.811	0.862

表2 2组子宫肌瘤患者围手术期相关指标比较(

±s)

组别	例数	术中出血量(mL)	手术时间(min)	术后肛门排气时间(d)	术后住院时间(d)
LUAO-M组	60	88.1±27.5	106.0±22.4	2.0±0.3	5.5±2.9
LM组	60	141.6±52.1	121.0±23.1	2.7±0.8	7.0±2.2
t值		6.02	3.10	5.86	2.76
P值		0.001	0.003	0.001	0.007

表2 2组子宫肌瘤患者围手术期相关指标比较(

±s)

组别	例数	术中出血量(mL)	手术时间(min)	术后肛门排气时间(d)	术后住院时间(d)
LUAO-M组	60	88.1±27.5	106.0±22.4	2.0±0.3	5.5±2.9
LM组	60	141.6±52.1	121.0±23.1	2.7±0.8	7.0±2.2
t值		6.02	3.10	5.86	2.76
P值		0.001	0.003	0.001	0.007

表3 2组子宫肌瘤患者术前、术后不同时点的激素水平比较(

±s)

组别	例数	FSH(mIU/mL)			LH(mIU/mL)			雌二醇(pg/mL)
组别	例数	术前	术后7 d	术后21 d	术前	术后7 d	术后21 d	术前	术后7 d	术后21 d
LUAO-M组	60	18.1±2.5	21.0±3.4	19.0±2.3	19.5±3.9	24.1±4.6	20.3±3.1	271.6±20.4	261.5±17.4	269.4±18.0
LM组	60	18.6±2.1	25.0±3.1	21.7±3.8	19.0±3.2	29.7±5.0	25.5±4.7	272.0±20.4	245.0±15.8	257.3±16.5
F_治疗值/P_治疗值		34.42/<0.001			45.52/<0.001			66.43/<0.001
F_时间值/P_时间值		16.63/<0.001			47.83/<0.001			59.53/<0.001
F_{治疗×时间}值/P_{治疗×时间}值		9.33/<0.001			50.63/<0.001			47.32/<0.001

表3 2组子宫肌瘤患者术前、术后不同时点的激素水平比较(

±s)

组别	例数	FSH(mIU/mL)			LH(mIU/mL)			雌二醇(pg/mL)
组别	例数	术前	术后7 d	术后21 d	术前	术后7 d	术后21 d	术前	术后7 d	术后21 d
LUAO-M组	60	18.1±2.5	21.0±3.4	19.0±2.3	19.5±3.9	24.1±4.6	20.3±3.1	271.6±20.4	261.5±17.4	269.4±18.0
LM组	60	18.6±2.1	25.0±3.1	21.7±3.8	19.0±3.2	29.7±5.0	25.5±4.7	272.0±20.4	245.0±15.8	257.3±16.5
F_治疗值/P_治疗值		34.42/<0.001			45.52/<0.001			66.43/<0.001
F_时间值/P_时间值		16.63/<0.001			47.83/<0.001			59.53/<0.001
F_{治疗×时间}值/P_{治疗×时间}值		9.33/<0.001			50.63/<0.001			47.32/<0.001

表4 2组子宫肌瘤患者术前、术后不同时点血清炎症因子水平比较(

±s)

组别	例数	TNF-α(μg/L)			IL-1(μg/L)			IL-6(μg/L)
组别	例数	术前	术后24 h	术后72 h	术前	术后24 h	术后72 h	术前	术后24 h	术后72 h
LUAO-M组	60	1.4±0.3	2.9±0.9	2.7±0.7	6.4±2.1	25.3±7.1	22.5±5.3	7.1±2.1	37.5±9.4	33.4±8.2
LM组	60	1.5±0.4	4.3±1.1	3.8±1.0	6.3±2.0	39.8±9.2	29.0±7.4	7.2±2.4	45.5±10.9	39.6±11.8
F_治疗值/P_治疗值		22.42/<0.001			33.62/<0.001			48.34/<0.001
F_时间值/P_时间值		15.35/<0.001			25.43/<0.001			32.53/<0.001
F_{治疗×时间}值/P_{治疗×时间}值		3.35/<0.001			10.62/<0.001			16.53/<0.001

表4 2组子宫肌瘤患者术前、术后不同时点血清炎症因子水平比较(

±s)

组别	例数	TNF-α(μg/L)			IL-1(μg/L)			IL-6(μg/L)
组别	例数	术前	术后24 h	术后72 h	术前	术后24 h	术后72 h	术前	术后24 h	术后72 h
LUAO-M组	60	1.4±0.3	2.9±0.9	2.7±0.7	6.4±2.1	25.3±7.1	22.5±5.3	7.1±2.1	37.5±9.4	33.4±8.2
LM组	60	1.5±0.4	4.3±1.1	3.8±1.0	6.3±2.0	39.8±9.2	29.0±7.4	7.2±2.4	45.5±10.9	39.6±11.8
F_治疗值/P_治疗值		22.42/<0.001			33.62/<0.001			48.34/<0.001
F_时间值/P_时间值		15.35/<0.001			25.43/<0.001			32.53/<0.001
F_{治疗×时间}值/P_{治疗×时间}值		3.35/<0.001			10.62/<0.001			16.53/<0.001

表5 2组子宫肌瘤患者术后并发症发生率比较[例数(%)]

组别	例数	发热	感染	腹痛	闭经	阴道出血	性功能障碍	肠梗阻	总发生率
LUAO-M组	60	1(1.7)	1(1.7)	1(1.7)	1(1.7)	1(1.7)	0(0)	0(0)	5(8.3)
LM组	60	3(5.0)	3(5.0)	1(1.7)	2(3.3)	3(3.0)	1(2.3)	1(1.7)	14(23.3)
χ²值		－	－	－	－	－	－	－	5.07
P值		－	－	－	－	－	－	－	0.024

表5 2组子宫肌瘤患者术后并发症发生率比较[例数(%)]

组别	例数	发热	感染	腹痛	闭经	阴道出血	性功能障碍	肠梗阻	总发生率
LUAO-M组	60	1(1.7)	1(1.7)	1(1.7)	1(1.7)	1(1.7)	0(0)	0(0)	5(8.3)
LM组	60	3(5.0)	3(5.0)	1(1.7)	2(3.3)	3(3.0)	1(2.3)	1(1.7)	14(23.3)
χ²值		－	－	－	－	－	－	－	5.07
P值		－	－	－	－	－	－	－	0.024

表6 2组子宫肌瘤患者随访结果比较

组别	例数	月经量过多缓解率[例数(%)]	闭经率[例数(%)]	肌瘤复发率[例数(%)]	子宫体积缩小率(%，±s)	1年PFS率[例数(%)]
LUAO-M组	60	58(96.7)	2(3.3)	3(5.0)	48.1±14.6	57(95.0)
LM组	60	36(60.0)	2(3.3)	4(6.7)	35.1±10.1	35(58.3)
统计量		χ²＝13.35	χ²＝0.26	χ²＝0.15	t＝4.86	χ²＝12.46
P值		<0.001	0.610	0.697	0.001	<0.001

表6 2组子宫肌瘤患者随访结果比较

组别	例数	月经量过多缓解率[例数(%)]	闭经率[例数(%)]	肌瘤复发率[例数(%)]	子宫体积缩小率(%，±s)	1年PFS率[例数(%)]
LUAO-M组	60	58(96.7)	2(3.3)	3(5.0)	48.1±14.6	57(95.0)
LM组	60	36(60.0)	2(3.3)	4(6.7)	35.1±10.1	35(58.3)
统计量		χ²＝13.35	χ²＝0.26	χ²＝0.15	t＝4.86	χ²＝12.46
P值		<0.001	0.610	0.697	0.001	<0.001

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