子宫附件切除对女性生殖激素的影响

Influence of hysterectomy and adnexectomy on reproductive hormones

目的探讨不同术式的子宫附件切除对女性生殖激素的影响。方法将65例40～45岁月经周期规则的良性妇科肿瘤患者按不同术式分为3组:组Ⅰ(n=22)行单纯次全子宫切除术;组Ⅱ(n=23)行单纯全子宫切除术;组Ⅲ(n=20)行次全子宫切除术加一侧附件切除术。各组于术前1 d及术后1周、3个月、1年分别测定血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、催乳素(PRL)的水平,比较各种激素手术前后的变化。结果术后1周,各组E2均较术前1 d明显降低(P<0.05);之后各组E2逐渐上升,术后1年时组Ⅰ、组Ⅱ基本接近术前水平,但组Ⅲ仍较术前显著降低(P<0.05)。术后3个月时各组FSH、LH较术前1 d及术后1周明显升高(P<0.05);术后1年时各组FSH、LH仍较术前1 d显著升高(P<0.05),组Ⅰ、组Ⅱ中FSH、LH较术后3个月时下降(P<0.05)。术后1周,各组PRL均较术前明显升高(P<0.05)。结论不同术式的子宫附件切除术后,近期表现为E2明显下降,PRL显著上升,以后逐渐恢复。FSH、LH术后3个月时明显升高,之后可能因为卵巢通过血管再生及局部内环境的调整,FSH及LH逐渐下降,1年后仍不能恢复至术前水平,提示卵巢储备功能下降。次全子宫切除术及一侧附件切除术后,卵巢储备功能下降更明显。

Objective To explore the effects of different patterns of hysterectomy and adnexectomy on reproductive hormones. Methods Sixty-five hospitalized patients aged from 40 to 45 years with benign gynecologic tumors and regular menstruation were divided into 3 groups according to different surgical procedures: group Ⅰ(n=22),subtotal hysterectomy;group Ⅱ(n=23),total hysterectomy;group Ⅲ(n=20),subtotal hysterectomy plus unilateral adnexectomy.The serum levels of follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2) and prolactin(PRL) were detected 1 d before operation,and 1 week,3 months and 1 year after operation. Results One week after operation,E2 levels of all groups were significantly lower than that of 1 d before operation(P<0.05).Then E2 levels increased gradually in all groups,and 1 year after operation,E2 levels in group Ⅰ and group Ⅱ were close to that of before operation,while E2 level in group Ⅲ was still significantly lower than that of before operation(P<0.05).The levels of FSH and LH of 3 months after operation were significantly higher than those of 1 d before operation and 1 week after operation in all groups(P<0.05).One year after operation,the levels of FSH and LH were significantly higher than those of before operation in all groups,and the levels of FSH and LH in group I and group II were significantly lower than those of 3 months after operation(P<0.05).One week after operation,the levels of PRL in all groups were significantly higher than those of before operation(P<0.05). Conclusion After hysterectomy with or without unilateral adnexectomy,the level of E2 may significantly decrease and that of PRL significantly increase in short term,which may recover gradually.The levels of FSH and LH may significantly increase 3 months after operation,and then decrease gradually.But in long term,the function of ovary can not recover to that of before operation,and the operations can cause premature ovarian failure.The tendency of ovarian failure is most significant after subtotal hysterectomy plus unilateral adnexectomy.