腹腔镜下保留血管的次全子宫切除术效果研究

Effects of laparoscopic subtotal hysterectomy preserving vessels

目的 探讨腹腔镜下保留子宫血管的次全子宫切除术效果及术后内分泌变化.方法 将2007年1月1日-2008年12月31日因子宫良性病变需行腹腔镜下子宫次全切除术患者54例随机分为保留子宫血管次全子宫切除术组（研究组,n=15）和传统次全子宫切除术组（对照组,n=39）,比较两组手术时间、术中出血量、术后排气时间,同时在术前卵泡晚期抽取患者静脉血测定血清雌二醇、卵泡刺激素、黄体生成素,并于术后4个月、术后1年、术后2年抽血复查.结果 两组手术时间、术中出血量、术后排气时间比较无显著性差异（均P〉0.05）.对照组术后卵泡刺激素、黄体生成素明显增高（均P〈0.05）,雌二醇水平术后4个月、术后1年、术后2年较术前降低（t/t＇分别为7.98、6.62、5.09,P〈0.05）;研究组手术前后血清性激素水平比较无显著性差异（均P〉0.05）.结论 腹腔镜下保留子宫血管的次全子宫切除术与传统腹腔镜下次全子宫切除术相比,术式难度无明显增大,对卵巢内分泌功能的影响较小,是临床上一种可行的手术方法.

Objective To investigate the effects of laparoscopic subtotal hysterectomy preserving vessels and the endocrine changes after operation. Methods 54 patients with uterine benign lesion were randomly divided into two groups, which were respectively treated with artery-sparing laparoscopic subtotal hysterectomy （study group, n = 15 ） and traditional subtotal hysterectomy （control group, n = 39 ）. Average operating time, intraoperative blood loss, postoperative exhaust time and serum hormones （FSH, LH, E2 ） levels of 4 months, 1 year and 2 years after operation were compared between two groups. Results No differences in average operating time,intraoperative blood loss and postoperative exhaust time were observed between two groups （ P 〉 0. 05 ）. Study group showed no significant changes of blood hormones after operation （ all P 〉 0.05 ）. However, much higher FSH and LH levels （ t/t＇ = 7.98,6.62,5.09, P 〈 0.05 ） and lower E2 level （ P 〈 0.05 ） after operation were detected in control group. Conclusion Compared with traditional laparoscopic subtotal hysterectomy, laparoscopic subtotal hysterectomy preserving vessels is not difficult and has less effect on ovarian function. It is a kind of feasible surgical operation method.