腹腔镜与开腹子宫次全切除术的疗效比较及对卵巢功能的影响

Laparoscopic and Abdominal Subtotal Hysterectomy:Comparison of Curative Effects on Ovarian Function

目的探讨腹腔镜子宫次全切除术与开腹子宫次全切除术的疗效比较及对卵巢功能的影响。方法 60例有子宫次全切除术指征的子宫良性病变患者者随机分为腹腔镜组和开腹组各30例,观察比较两组的手术效果及术前术后不同时间两组对卵巢功能近远期的影响。结果腹腔镜组的手术时间、自觉症状缓解时间、伤口愈合时间及术后起床活动时间、术后住院时间均明显短于开腹组(P<0.05)。腹腔镜组术后24个月E2、P、INHB较术前比较明显下降,FSH、LH与术前比较均明显升高。开腹组术后6个月、12个月、24个月的E2、P、INHB均较术前明显下降,FSH、LH较术前明显升高。且开腹组术后6个月、12个月E2、P、INHB水平均较腹腔镜组明显下降,而术后6个月、12个月开腹组FSH、LH水平较腹腔镜组明显提高。结论腹腔镜下次全子宫切除术能维持卵巢功能,手术效果明显优于传统开腹组。

Objective To explore the curative effect comparison of laparoscopic subtotal hysterectomy with abdominal subtotal hysterectomy on ovarian function. Methods Sixty cases of uterus benign lesions with subtotal hysterectomy indication were randomly divided into laparo- scopic subtotal hysterectomy group and abdominal subtotal hysterectomy group,with 30 cases in each. The hysterectomy effects and the short and long term effects of the hysterectomy on ovarian function before and after surgery in the two groups were observed and compared. Results Operative time,symptom relief time,wound healing time and postoperative activity time and postoperative hospital stay in the laparoscopic subtotal hysterectomy group were significantly shorter than those of the abdominal subtotal hysterectomy group （P〈0.05）. In the laparscopic subtotal hysterectomy group ,E2 ,P and INHB were significantly decreased 24 months after surgery compared with those before surgery,and FSH and LH were significantly increased compared with that before surgery. In the abdominal subtotal hysterectomy group ,E2,P and INHB were significantly decreased 6,12 and 24 months after surgery compared with those before surgery,and FSH and LH were significantly higher than those before surgery. E2, P and INHB were significantly lowered and FSH and LH were significantly higher in the abdominal subtotal hysterectomy group 6 and 12 months after surgery compared with the laparoscopic subtotal hysterectomy group. Conclusion Laparoseopic subtotal hysterectomy is superior to abdominal subtotal hysterectomy in the maintenance of ovarian function.