目的 探讨子宫切除术与子宫肌瘤剔除术治疗多发性子宫肌瘤（肌瘤数目≥4个）患者的临床疗效及生活质量，为患者的治疗选择提供依据。方法 选择2023年8月至2024年6月因多发性子宫肌瘤（肌瘤数目≥4个）在郑州大学第一附属医院行手术治疗的患者，根据手术方式分为子宫切除术组和子宫肌瘤剔除术组，分析两组基线资料。采用倾向性评分匹配（propensity score matching， PSM）按照1∶1 匹配后，比较两组患者围术期资料、生活质量及卵巢功能的差异。结果 最终纳入495例患者，其中，子宫切除术组256例，子宫肌瘤剔除术组239例。子宫切除术组中年龄较大、体质指数（BMI）较高 、孕产次多、无生育需求、存在临床症状及合并症、肌瘤数目>10个的患者占比较高，差异均有统计学意义（均P<0.05）。经PSM后，两组各有患者95例。子宫切除术组较子宫肌瘤剔除术组患者子宫体积大 [（291.10±218.79）cm³ vs.（217.19±166.84）cm³，P<0.05]，且差异具有统计学意义。相较于子宫肌瘤剔除术组，子宫切除术组术中出血量少[（40.11±15.89）mL vs.（106.11±43.86）mL]、手术时间短[（109.42±44.12）min vs. （135.85±60.42）min]、术后排气时间早[1（1，1）d vs. 1（1，2）d]、留置引流管比例小（6.4% vs. 26.3%）、术后使用镇痛药比例低（15.8% vs. 33.7%）、术后拔除引流管时间短[2.5（2，3）d vs. 3（2，3）d]、术后住院时间短[4（3，5）d vs. 4（4，5）d]、症状缓解率高（96.7% vs. 77%），且差异均有统计学意义（均P<0.05）。两组间生活质量评分量表（SF-36）、性功能指数（FSFI）、焦虑自评量表（SAS）、抑郁自评量表（SDS）评分在术前、术后3个月、术后6个月对比差异均无统计学意义（均P>0.05）。与术前相比，各组的SF-36在术后3个月均有显著下降，在术后6个月均有显著升高（均P<0.05）。子宫切除术组的Kuppermann评分分别在术前、术后3个月、术后6个月均高于子宫肌瘤剔除术组（均P<0.05），然而，术前术后变化值在两组间差异均无统计学意义（均P>0.05）。术前、术后子宫切除术组抗米勒管激素（AMH）均低于子宫肌瘤剔除术组，差异有统计学意义（均P<0.05）。各组术后AMH较术前变化均无统计学意义 （均P>0.05）。结论 子宫切除术治疗4个及以上多发性子宫肌瘤的疗效优于子宫肌瘤剔除术者，且对术后短期生活质量与卵巢功能无显著影响。

Objective To explore the clinical efficacy and quality of life between hysterectomy and myomectomy in patients with multiple uterine fibroids （≥4 lesions） ，and to provide evidence for surgical options. Methods The patients undergoing surgical treatment for multiple uterine fibroids （≥4 lesions） at the First Affiliated Hospital of Zhengzhou University from August 2023 to June 2024 were selected. Participants were grouped into hysterectomy group and myomectomy group. The baseline data of the two groups were analyzed. Propensity score matching （PSM） was performed to match at 1∶1，after which the differences in perioperative data，quality of life （QoL），and ovarian function were compared between the two groups. Results The study enrolled 495 patients，of whom 256 patients were in the hysterectomy group and 239 patients in the myomectomy group. The hysterectomy group exhibited higher proportions of patients with age≥40 years，BMI ≥25 ，multiparity，absence of fertility requirements，symptomatic presentation，anemia，preoperative blood transfusion，adenomyoma/adenomyosis comorbidity，hypertension/diabetes comorbidity，and fibroid counts>10 （all P<0.05）. After PSM，95 patients were included in each group. The hysterectomy group demonstrated significantly larger uterine volume [（291.10±218.79） cm³ vs. （217.19±166.84） cm³，P<0.05], and the difference was statistically significant. Compared to myomectomy，hysterectomy was associated with less intraoperative blood loss [（40.11±15.89） mL vs.106.11±43.86） mL]，shorter operative duration [（109.42±44.12） min vs. （135.85±60.42） min]，earlier postoperative flatus [1 （1，1）d vs. 1 （1，2） d]，lower proportion of drainage tube placement （6.4% vs. 26.3%），less postoperative analgesia use （15.8% vs. 33.7%），shorter drainage tube retention [2.5 （2，3）d vs. 3 （2，3） d]，shorter hospitalization [4（3，5）d vs. 4 （4，5） d]，and higher rate of symptom relief （96.7% vs. 77%）, with all the differences being statistically significant （all P<0.05）. No significant intergroup differences were observed in SF-36，FSFI，SAS，or SDS scores across preoperative，3-month，and 6-month postoperative assessments （all P>0.05）. Both groups exhibited transient SF-36 decline at 3 months after surgery followed by significant improvement at 6 months after surgery（all P<0.05）. Hysterectomy group maintained higher Kuppermann scores than the myomectomy group before surgery and at 3 months and 6 months after surgery （P<0.05），though score changes before and after surgery showed no intergroup differences（all P>0.05）. Preoperative and postoperative AMH was lower in the hysterectomy group than in the myomectomy group，and the difference was statistically significant （all P<0.05）. There was no statistically significant change in preoperative and postoperative AMH in each group（all P>0.05）. Conclusion For patients with multiple uterine fibroids (≥4)，hysterectomy demonstrates superior clinical efficacy compared to myomectomy without compromising QoL and ovarian function in the short term.