子宫和/或单侧附件切除术对受术者性激素水平的影响

Changes of levels of sex hormones after hysterectomy and/or unilateral uterine adnexectomy

目的:观察子宫和/或单侧附件切除手术后对受术者性激素的影响及其恢复途径。方法:138例良性妇科肿瘤患者按不同术式分为5组:Ⅰ组行单纯次全子宫切除术,Ⅱ组行单纯全子宫切除术,Ⅲ组行次全子宫切除术加一侧附件切除术,Ⅳ组行全子宫切除术加一侧附件切除术,Ⅴ组行单侧附件切除术。各组于术前、术后1周、3月、1年后测定血清性激素水平,比较手术前、后FSH、LH、E2、P、T、PRL的变化。结果:术后1周各组E2水平均降低,PRL水平上升,手术前后比较,差异有显著性(P<0.01)。FSH、LH、P、T未见明显差异。术后3月,各组E2水平均高于术后1周,差异有显著性(P<0.01,P<0.05)。各组PRL水平较术后1周下降,差异亦有显著性(P<0.01,P<0.05)。Ⅰ、Ⅱ、Ⅲ、Ⅳ组FSH水平均较术后1周上升,差异有显著性(P<0.01,P<0.05),Ⅴ组未见明显升高,差异无显著性(P>0.05)。手术1年后,各组E2水平继续上升,接近或达到术前水平,与术前差异无显著性(P>0.05)。Ⅱ、Ⅲ、Ⅳ组FSH水平继续上升,高于术前水平,差异有显著性(P<0.05)。Ⅰ组有上升趋势,但差异无显著性(P>0.05)。Ⅴ组术后3月就已下降至术前水平,与术前差异无显著性(P>0.05)。结论:子宫和/或单侧附件切除术后,近期对内分泌功能有不同程度的影响,以E2、PRL最敏感,E2水平明显下降,PRL显著上升,以后逐渐恢复。

Objective：To observe the changes of levels of sex hormones after hysterectomy and /or unilateral adnexectomy.Methods：One hundred and thirty-eight patients with benign gynecologic tumors were divided into 5groups according to different types of operations：groupⅠ（single subtotal hysterectomy）,group Ⅱ（single total hysterectomy）,group Ⅲ（subtotal hysterectomy plus unilateral uterine adnexectomy）,group Ⅳ（total hysterectomy plus unilateral uterine adnexectomy）,group Ⅴ（unilateral uterine adnexectomy）.The serum FSH,LH,E2,P,T,PRL levels were measured at the point of pre-operation,one week,three months and one year after operation respectively.Results：One week after operation,the E2 levels decreased（P〈0.01） and the PRL levels of each group increased （P〈0.01）.Comparing the levels of E2 and PRL pre-operation with those after-operation,there were significant difference.The levels of FSH,LH,P and T had no change.Three months after operation,the E2levels of each group were higher than those of one week after operation （P〈0.01 or P〈0.05）,While the PRL levelof each group descended to those of before operations （P〈0.01 or P〈0.05）.Before operation the FSH levels of group Ⅰ,Ⅱ,Ⅲ and Ⅳ increased compared with those after operations,there were significant difference （P〈0.01 or P〈0.05）,except group Ⅴ（P〉0.05）.One year after operation,the E2 level in each group continually increased to the level of before operations ,and there was no significant difference（P〉0.05）.The FSH levels increased in group Ⅱ,Ⅲ,and Ⅳ,which wer higher than those of before operations （P〈0.05）,and ther were no difference between group Ⅰand Ⅳ（P〉0.05）.Conclusion：After hysterectomy and/or unilateral adnexectomy,the ovarian funcion will be influenced in short-term.The most sensitive items are E2 and PRL,but they can resume gradually after operations.