Clinical Study Of Uterine Artery Occlusion In Laparoscopic Myomectomy

Purpose:To study the clinical application of different methods of uterine artery occlusion in laparoscopic myomectomy.Clinical data and methodsMaterials and methods:1.Clinical materialsSixty cases of uterine fibroids were selected.The surgical indications were clear,and the removal of uterine fibroids was strongly required to retain the uterus.The 60 patients were admitted to xishan people’s hospital of wuxi city from August 2016 to June 2017.No obvious abnormalities were found in preoperative cervical disease screening,and no obvious surgical contraindications were found in other examinations.Patients were selected from 38 to 48 years old.All myomas were intramural myomas.The uterine size ranges from two and a half months to four months.B-mode ultrasound was used to measure the number of uterine fibroids by 2-5 with a diameter of 5-9 cm.The patients were divided into three groups,each with 20 patients.There was no significant difference in the age,uterine size,preoperative hemoglobin,number,size and preoperative menstrual condition of the three groups.The surgery was performed by the same surgeon with extensive laparoscopic experience.2.Surgical methodIn group A,the main uterine artery was isolated by laparoscopy,and the uterine artery was temporarily blocked by no.7 silk thread.The pseudo capsule on the surface of uterine fibroids was injected with pituitrin.In group B,the main uterine artery was isolated by laparoscopy and permanently blocked by bipolar coagulation.In the C group,pituitrin was injected directly into the pseudo capsule on the surface of uterine fibroids under laparoscopy,and hysteromyoma was removed,while uterine artery occlusion was not performed,and wound suture was performed.Three groups of patients were treated with anti-inflammatory fluid infusion for three days postoperatively,and the differences in blood loss,operation time,postoperative hospitalization days,postoperative disease rate,exhaust time,postoperative menstrual excess,postoperative recurrence rate,preoperative and postoperative sex hormones(E2,LH,FSH)were observed.To understand the effect of uterine artery occlusion in the removal of uterine fibroids and its significance.3.Statistical methodsSPSS22.0 software was used for statistical analysis,and the quantitative data were tested for normality by using Shapiro-Wilk.The classification data were tested by 2 test and the condition was not met by Fisher exact probability method.Repeated measures anova was used to analyze the repeated measurement data.Three groups at different time points were compared and within different time points were compared using Bonferroni method for simple effect analysis.Test level was 0.05,p<0.05,and the difference was statistically significant.Results:There were statistically significant differences among the three groups in terms of intraoperative blood loss,operation time,one year postoperative menstrual improvement,and recurrence rate(P<0.05).There was no significant difference in length of stay,postoperative morbidity and postoperative exhaust time(P>0.05).Preoperative and postoperative sex hormones(E2,LH,FSH)were all within the normal range of follicular phase,Compared with the sex hormone levels of the 3 groups before surgery,3 months after surgery,6 months after surgery and 1 year after surgery,FSH increased and E2 level decreased in the 3 months after surgery in group B,showing statistical difference(P<0.05),There was no statistical difference between 6 months after surgery and 12 months after surgery(P>0.05),There was no statistically significant difference in LH at different time points in group B(P>0.05),and no statistically significant difference in hormone levels at different time points in group A and C(P>0.05).The E2 level of group B was significantly lower than that of group A and C in the three months after surgery(P<0.05),while there was no significant difference between the other three groups(P>0.05).Conclusion:1.LUAO-M has short operation time,obvious improvement of symptoms of menorrhagia and low recurrence rate of myoma,which is worth promoting.2.LUAO-M is recommended for symptomatic patients with uterine fibroids who wish to retain the uterus.The technique of uterine artery occlusion is very demanding.3.Temporary uterine artery occlusion has no effect on ovarian function,while the effect of permanent occlusion on ovarian function is reversible and transient.