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目的探讨腹腔镜保留子宫血管次全子宫切除术的可行性及临床应用价值。方法将58例因妇科良性疾病需要手术治疗的患者,根据手术方式不同,分为腹腔镜保留子宫血管次全子宫切除和传统的腹腔镜次全子宫切除术。统计不同术式的手术时间、术中出血量、术后病率情况;两组患者分别于术前、术后3个月、6个月、1年、2年抽血测定促卵泡生成素(FSH)、促黄体生成素(LH)、雌二醇(E2)水平,并对患者性生活障碍、更年期症状进行随访。结果两组的手术时间、术中出血量、术后病率无统计学差异;对照组术后测定促卵泡生成素(FSH)、雌二醇(E2)明显升高(P<0.05),促黄体生成素(LH)无明显变化(P>0.05),雌二醇(E2)水平降低(P<0.05),实验组患者促卵泡生成素(FSH)、雌二醇(E2)无明显变化。术后性生活障碍、围绝经期症状发生率实验组较对照组明显降低。结论对于年轻的因良性疾病需要切除子宫的患者,保留子宫血管次全子宫切除术,既子宫切除,又保留了卵巢动脉上行支,因此保留输卵管及卵巢间血管网的完整性,卵巢功能的影响较传统次全子宫切除小,降低术后更年期期症状及性功能障碍的发生,且不增加术中出血、手术时间及术后病率的发生。
Objective To investigate the feasibility and clinical value of laparoscopic uterine vascular hysterectomy. Methods Fifty-eight patients with benign gynecological diseases requiring surgical treatment were divided into laparoscopic hysterectomy and traditional laparoscopic subtotal hysterectomy according to different surgical methods. The operation time, intraoperative blood loss and postoperative morbidity rate were calculated according to the different surgical procedures. The two groups of patients were tested for follicle stimulating hormone (pretreatment, 3 months, 6 months, 1 year, 2 years) FSH, LH and E2, and follow-up of patients with sexual dysfunction and menopause. Results The operation time, intraoperative blood loss and postoperative morbidity were not significantly different between the two groups. The levels of FSH and E2 in the control group were significantly increased (P <0.05) Luteinizing hormone (LH) showed no significant change (P> 0.05), estradiol (E2) decreased (P <0.05), but FSH and E2 did not change in experimental group. Postoperative sexual dysfunction, perimenopausal symptoms in experimental group compared with the control group was significantly lower. Conclusions For young patients with benign disease requiring uterine resection, uterine vascular hysterectomy is retained, both hysterectomy and the supranuclear branch of the ovary are retained, thus preserving the integrity of the vascular network between the fallopian tubes and the ovary and the effects of ovarian function Less than the traditional subtotal hysterectomy to reduce postmenopausal symptoms and sexual dysfunction, and does not increase intraoperative bleeding, operative time and postoperative morbidity.