腹腔镜与开腹子宫次全切除术对卵巢功能的影响

The effect of ovarian function under subtotal abdominal hysterectomy and subtotal laparoscopic hysterectomy

目的:观察腹腔镜子宫次全切除术的手术效果,并与开腹子宫次全切除术的手术效果比较,同时观察两种术式对卵巢功能的影响。方法:选择我院2008年9月～2010年9月收治的孕产妇2 395例,其中,64例患者行子宫切除术治疗,根据手术方法的不同64例患者随机分为腹腔镜组和开腹组,各32例,观察比较两组的平均手术时间、术中平均失血量、术后肛门排气时间、术后下床活动时间、术后住院时间,以及分别于术前、术后3个月测定血清中卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)的变化情况,从而观察对卵巢功能的影响。结果:与开腹手术组相比,腹腔镜组的平均手术时间、术中平均失血量、术后肛门排气时间、术后下床活动时间、术后住院时间均明显短于开腹组,差异有统计学意义(P<0.05)。两组患者术前血清FSH、LH、E2水平比较,差异无统计学意义(P>0.05)。治疗后3个月后开腹组的血清E2水平高于腹腔镜组,而血清FSH、LH水平则低于腹腔镜组,差异均有统计学意义(均P<0.05)。结论:腹腔镜子宫次全切除术手术效果优于开腹手术,对卵巢功能影响小。

Objective： To observe the efficacy of subtotal laparoscopic hysterectomy, and compare with the effect of subtotal abdominal hysterectomy, and to observe the effect of the surgerical methods for the ovarian function. Methods： 64 pa- tients were randomly assigned to laparoseopic group and abdominal group according to surgical methods, and to compare the average operation time, mean blood loss, anal exhaust time, postoperative ambulation, postoperative hospital stay, and to test serum follicle stimulating hormone （FSH）, luteinizing hormone （LH）, estradiol （E2） before surgery respectively, after measured 3 months, and thus to observe the influence on ovarian function. Results： The average operation time, mean blood loss, anal exhaust time, postoperative ambulation, postoperative hospital stay of the laparoscopic group were significantly shorter than those of the abdominal group, there were significant differences （P〈0.05）. In the two groups of patients, serum FSH, LH, E2 levels compared before surgery, there was no significant difference （P〉0.05）. After 3 months treatment, serum E2 levels of abdominal group was higher than that of the laparoscopic group, while serum FSH, LH level was lower than that of the laparoscopic group （all P〈0.05）. Conclusion： Subtotal laparoscopic hysterectomy surgery are better than abdominal surgery patients, and it has little effect on ovarian function.