不同手术方式治疗子宫肌瘤对生殖内分泌激素的影响

Influence of different operation modes in treatment of leiomyoma on reproductive endocrine hormone levels

目的探讨如何选择最合理的手术方式以利保护患者的卵巢功能。方法对103例49岁以下的未绝经子宫肌瘤患者根据术式分成3组:子宫肌瘤挖除术组(Ⅰ组),33例;次全子宫切除术组(Ⅱ组),30例;全子宫切除术组(Ⅲ组),40例。术前测定血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇、孕酮;对60例子宫切除患者于术前进行彩色多普勒超声检查,测定卵巢动脉的收缩期最大血流速度(Vmax),舒张末期最小血流速度(Vmin),阻力指数(RI),搏动指数(PI)。分别在术后3、6个月进行随访。结果Ⅰ组患者不论年龄大小,手术前后 FSH、LH、雌二醇、孕酮差异均无统计学意义(P>0.05)。Ⅱ组及Ⅲ组术后6个月与术前比较雌二醇水平差异有统计学意义(均 P<0.05),FSH、LH、孕酮差异均无统计学意义(P>0.05)。Ⅲ组40岁以上患者雌二醇水平术后6个月为(322±212)pmol/L,术前为(589±458)pmol/L,P<0.01。子宫切除术后卵巢动脉 Vmax、Vmin 值下降,阻力指数、搏动指数升高,术后6个月 Vmax 为(0.24±0.04)m/s,Vmin 为(0.05±0.05)m/s,阻力指数为0.80±0.05,搏动指数为2.06±0.24。结论 (1)子宫肌瘤挖除术对患者卵巢功能无影响。(2)全子宫切除术及次全子宫切除术均可影响卵巢血供及内分泌功能,尤其对40岁以上患者有明显影响,且半年内即可发生。

Objective To explore the most reasonable operation mode for treatment of leiomyoma so as to protect the ovary function of the patients Methods 103 leiomyoma patients under the age of 49 received different operation： myomectomy （ Group Ⅰ, n = 33 ）, subtotal hysterectomy （ Group Ⅱ, n = 30）, and hysterectomy （ Group m, n =40）. The levels of serum estradiol （E2）, progesterone （ P）, luteinizing hormone （ LH）, and follicle stimulating hormone （FSH） were detected before operations and 3 and 6 months after operations. Sixty patients underwent color Doppler ultrasonography before and after hysterectomy or subtotal hysterectomy to measure the blood flow of ovary artery . The maximal systolic flow velocity （Vmax）, end-diastolic minimal flow velocity （Vmin）, resistance index （RI）, and pulsatility index （PI） were calculated. Results There were no significant differences in the levels of E2 , P, LH, and FSH before and after operation among the patients of Group Ⅰ regardless of the age （ all P 〉 0.05 ） The E2 levels 6 months after operation of Group Ⅱ and Group Ⅲ were beth significantly lower than those before operation （beth P 〈 0.05）, however, the P, LH, and FSH levels before and after operation were not significantly different in these 2 groups （all P 〉 0.05 ）. The E2 level 6 months after operation of the patients aged ≥40 in group III decreased much more significantly to（362±252） pmol/L, with a greater statistical difference in comparison with that before operation, （567 ±417） pmol/L （P 〈 0.01 ）. The values of Vmax and Vmin of the ovary artery 6 months after operation were ：0.24 ± 0.04 m/s and 0.05± 0.05 m/s respectively, beth significantly lower than those before operation, （0.50±0. 11 m/s and 0. 17 ±0.24 m/s respectively, beth P 〈0. 01 ）. The values of RI and PI 6 months after operation were： 0. 80 ±0. 05 and 2. 06±0. 24 respectively, beth significantly higher than those before operation （0. 74 ± 0.05 and 1.62 ± 0. 33 respectively, beth P 〈 0. 01 ）. Conclusion Myomectomy doesn＇t influence the ovary function. Both subtotal hysterectomy and hysterectomy decrease the ovary blood flow and endocrine function 6 months after operations.