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目的:探讨不同子宫手术方式对生育期妇女卵巢功能的影响。方法:选取因生殖系统疾病行手术治疗的180例生育期女性患者,检测术前、术后6个月的血FSH、E2、AMH,并评估其潮热等更年期症状。结果:术前和术后6个月患者均未出现卵巢功能衰竭。与术前比较,年龄>40岁者术后6个月的AMH显著下降(P<0.05)。子宫肌瘤剔除术的患者术前AMH为(3.54±1.31)ng/ml,术后(3.69±1.35)ng/ml,差异无统计学意义(P=0.612)。与术前比较,子宫次全切除术患者术后AMH降低,但差异无统计学意义;子宫全切术(包括筋膜外子宫全切术)患者的术后AMH显著降低[(1.45±0.68)ng/ml vs(1.80±0.96)ng/ml,P<0.05];广泛性子宫切除术患者的术后AMH显著降低[(2.72±1.08)ng/ml vs(3.31±0.92)ng/ml,P<0.05];腹腔镜下子宫切除术患者的术后AMH显著降低[(1.56±1.00)ng/ml vs(1.94±1.10)ng/ml,P<0.05]。结论:子宫手术短期内不会导致卵巢功能衰竭,年龄、子宫切除方式与途径可能是子宫手术后短期内卵巢储备功能下降的影响因素。
Objective: To investigate the effect of different methods of uterine surgery on ovarian function in women of reproductive age. Methods: A total of 180 female patients with reproductive system diseases undergoing surgical treatment were selected. The blood levels of FSH, E2 and AMH were measured preoperatively and 6 months after operation. The symptoms such as hot flashes and menopause were also evaluated. Results: No ovarian failure occurred in preoperative and postoperative 6 months. Compared with the preoperative, AMH of patients aged> 40 years old at 6 months after operation decreased significantly (P <0.05). The preoperative AMH was (3.54 ± 1.31) ng / ml in patients with myomectomy and (3.69 ± 1.35) ng / ml postoperatively, with no significant difference (P = 0.612). Compared with the preoperative, patients with subtotal hysterectomy had lower AMH, but the difference was not statistically significant. AMH was significantly decreased in patients undergoing hysterectomy (including extrafascial hysterectomy) [(1.45 ± 0.68) (2.72 ± 1.08) ng / ml vs (3.31 ± 0.92) ng / ml, P (P <0.05); P <0.05]. The postoperative AMH was significantly lower in patients undergoing laparoscopic hysterectomy [(1.56 ± 1.00) ng / ml vs (1.94 ± 1.10) ng / ml, P <0.05]. Conclusion: Uterine surgery will not lead to ovarian failure in short term. Age, hysterectomy and pathways may be the influencing factors of ovarian reserve decline in short term after uterine surgery.