子宫肌瘤不同术式对卵巢功能影响的研究

Study on ovarian function after different uterine leiomyoma operations

目的:研究子宫肌瘤不同术式对绝经过渡期女性卵巢功能的影响。方法:对144例绝经过渡期女性因子宫肌瘤行不同术式治疗的患者,测定术前、术后3个月、术后6个月血E2、P、T、FSH、LH、PRL激素水平;回顾性研究术后1年内更年期症状。更年期症状与正常同年龄对照组比较。结果:全子宫切除组、次全子宫切除组在40～44岁年龄段术后3个月E2下降,FSH上升,与术前和肌瘤剔除组相比差异有显著性;术后6个月各种激素水平与术前和肌瘤剔除组相比差异无显著性;术后潮热症状和总体更年期症状与肌瘤剔除组和对照组相比差异有显著性。全子宫切除组、次全子宫切除组在45～50岁年龄段各激素水平在术后3个月与术前和肌瘤剔除组相比差异无显著性;术后6个月E2下降,FSH上升,与术前和术后3个月及肌瘤剔除组相比差异有显著性;潮热症状和总体更年期症状差异无显著性。全子宫切除组、次全子宫切除组比肌瘤剔除组、对照组更年期症状出现率高。结论:子宫切除术在45～50岁年龄段术后6个月对卵巢功能有影响,使之提早衰退。绝经过渡期体内性激素水平波动变化、更年期症状与激素水平变化可以不同步,卵巢衰退的诊断应根据多方面表现综合判断。子宫切除后增加了更年期症状出现比率。

Objective： Study on ovarian function after different uterine leiomyoma operation in premenopause women. Methods： 144 premenopausal patients aged between 40 and 50 years old with uterus leiomyoma were asked to participate in the study. Blood samples were drawn before surgery, three months and six months after surgery. Follicule - dtimulating hormone （FSH） and oestradiol （ E2 ）, progestogen （P）, luteotropic （LH）, testosterone （T）, prolactin （PRL） were assayed with the E- L method. Every visit patients filled in a questionnaire, containing questions about typical climacteric complaints and sexual function experienced both pre - and postoperatively. This observation lasted one year. Randomised controlled 56 healthy women at the same age. Results： 3 months after operation, the serum concentration of E2 went up and FSH declined in hysterectomy group （Ⅰ） and supracervical hysterectomy （Ⅱ） at the age of 40 -44 years old. There were significantly differences with preoperation or 6 month after operation （ P 〈 0. 05 ） and the same outcome was obtained comparison with hysteromyomectomy （Ⅲ） at the age of 40 - 44 years old at the same period （ P 〈 0. 05 ）. While 6 months after operation, the serum concentration of the six hormones was not significant difference with preoperation in hysterectomy group, supracervical hysterectomy and hysteromyomectomy group （ P 〉 0. 05 ）, and was no significant differences between three groups （ P 〉 0. 05 ）. Compared with preoperation, there were significant differences in hysterectomy group （Ⅴ） and supracervical hysterectomy （Ⅵ） at the age of 45 - 50 years old after 6 months operation （ P 〈 0. 05） but not for 3 months after operation （ P 〉 0. 05 ） in the serum concentration of E2 and FSH. There were significant differences between hysterectomy group or supracervical hysterectomy and hysteromyomectomy （Ⅶ） （ P 〈 0. 05） after 6 month. About climacteric symptoms, there were significant differences between Ⅰ or Ⅱ and Ⅲ or random control group （Ⅳ） at the age of 40 -44 after one year operation on flushing. The same outcome was obtained on proportion of overall climacteric symptoms. At the age of 45 -50 years old, although there were no significant differences between Ⅴ, Ⅵ and Ⅶ, Ⅷ, perhaps because of the samples small, the propertion＇s difference of typical climacteric symptoms as flushing and overall climacteric symptoms can be found. Conclusion： Hysterectomied （ hysterectomy, supracervical hysterectomy ） women, especially those up to 45 years, major uterine surgery may prelude an earlier onset of menopause. Though those aged 40 -44 years had no significant differences in the level of ovarian hormone, climacteric symptoms were higher than the normal control group. It suggested that wave changes of the serum concentration ovarian hormone were resulted the more climacteric symptoms than hysteromyomectomy and random control group. The diagnosis of ovarian failure should consider various aspects. The proportion of climacteric symptoms manifolded after operation.