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目的探讨子宫良性疾病行子宫切除术中同时切除双侧输卵管是否加重子宫切除对卵巢储备功能的负面影响。方法因子宫良性疾病行子宫切除患者60例,术中同时切除双侧输卵管患者30例为观察组,未同时切除双侧输卵管患者30例为对照组,比较术后6、18个月时2组患者窦卵泡数(antral follicle count,AFC)、卵泡刺激素(follicle-stimulating hormone,FSH)、黄体生成素(luteinizing hormone,LH)、雌二醇(estradiol,E_2)、FSH/LH、抗苗勒激素(anti-mullerian hormone,AMH)、三酰甘油(triacylglycerol,TG)、总胆固醇(total cholesterol,TC)、高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-D)、低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-D)、血清钙离子(Ca2+)水平及Kuppermann围绝经期症状评分、双侧卵巢体积的平均值(bilateral ovary average volume,BOV)。结果术后6个月,观察组AMH[0.61(0,6.90)μg/L]、AFC[1.0(0.5,2.0)个]水平较对照组[10.00(2.09,14.00)μg/L、2.0(1.5,3.0)个]明显降低(P<0.05);术后18个月,观察组AMH[1.50(0,2.10)μg/L]、AFC[0(0,1.0)个]较对照组[1.98(0.87,9.50)μg/L、2.0(0,2.0)个]明显降低,FSH[38.07(5.97,66.73)u/L]、LH[24.70(7.87,36.00)u/L]较对照组[22.90(5.8,30.0)u/L、6.86(1.67,17.66)u/L]明显升高(P<0.05);观察组术后18个月时FSH较术后6个月[9.42(7.33,19.73)u/L]明显升高(P<0.05),AFC及BOV[(2.64±1.44)cm3]较术后6个月时[BOV为(4.33±2.03)cm3]明显降低(P<0.05);对照组术后18个月时FSH及Kupperman评分[10(6,16)]较术后6个月时[Kupperman评分为5(0,10)]明显升高(P<0.05),AFC较术后6个月时明显降低(P<0.05);术后6、18个月2组血清E_2、TG、TC、HDL-D、LDL-D、Ca2+水平比较差异均无统计学意义(P>0.05)。结论与单纯子宫切除相比,子宫切除术中同时切除双侧输卵管可加重对卵巢储备功能的负面影响,但术后18个月内不会加剧因子宫切除导致的雌激素水平异常下降,对围绝经期症状及血脂、血钙无明显影响。
Objective To investigate the negative effects of simultaneous hysterectomy on ovarian reserve function in patients with benign uterine disease undergoing hysterectomy. Methods 60 patients underwent hysterectomy due to benign uterine diseases. Thirty patients with bilateral tubal resection at the same time were selected as the observation group. Thirty patients without bilateral tubal resection at the same time were selected as the control group. Antral follicle count (AFC), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E_2), FSH / LH, Anti-mullerian hormone (AMH), triacylglycerol (TG), total cholesterol (TC), high density lipoprotein-cholesterol (HDL-D), low density lipoprotein cholesterol low density lipoprotein-cholesterol (LDL-D), serum calcium (Ca2 +) level and Kuppermann perimenopausal symptom score, bilateral ovary average volume (BOV). Results The levels of AMH [0.61 (0,6.90) μg / L] and AFC [1.0 (0.5,2.0)] in the observation group were significantly higher than those in the control group [10.00 (2.09,14.00) μg / L, 2.0 (P <0.05) .After 18 months, AMH [1.50 (0,2.10) μg / L] and AFC [0 (0,1.0)] in the observation group were significantly lower than those in the control group [ 0.87,9.50) μg / L, 2.0 (0,2.0)] were significantly lower than those in the control group [FSH [38.07 (5.97,66.73) u / L] and LH [24.70 (7.87,36.00) 5.8, 30.0) u / L, 6.86 (1.67, 17.66) u / L] (P <0.05). At 18 months after operation, FSH in observation group was significantly higher than that in 6 months [9.42 (7.33, 19.73) (P <0.05); AFC and BOV [(2.64 ± 1.44) cm3] were significantly lower than those at 6 months (4.33 ± 2.03 cm3] FSH and Kupperman scores [10 (6,16)] at 18 months postoperatively were significantly higher than those at 6 months postoperatively (Kupperman score was 5 (0,10)] (P <0.05) (P <0.05). There was no significant difference in serum E2, TG, TC, HDL-D, LDL-D and Ca2 + levels between the two groups at 6 and 18 months after operation (P> 0.05). Conclusions Compared with simple hysterectomy, simultaneous resection of bilateral fallopian tubes during ovariectomy may have a negative effect on ovarian reserve function. However, estrogen levels caused by hysterectomy will not be exacerbated within 18 months after operation. Menopausal symptoms and blood lipids, serum calcium had no significant effect.