子宫切除对绝经前妇女卵巢功能的影响

The Impact of Hysterectomy on Ovarian Function of Premenopausal Women

目的：通过比较行子宫切除保留卵巢与未进行子宫切除绝经前妇女的卵巢功能,评估子宫切除后卵巢功能早衰风险。方法：选取解放军总医院妇产科2004～2007年收治的120例因患女性生殖系统良性疾病接收全子宫切除保留双侧卵巢的妇女为手术组,及135例未行子宫切除的绝经前妇女为对照组,每年对纳入对象进行血清检测以及问卷调查,详细记录数据4年。以血清FSH〉40 U/L为发生卵巢功能衰退,以危险率描述发生卵巢功能早衰的风险,利用COX比例风险模型进行统计学分析。结果：接受全子宫切除保留双侧卵巢的妇女中有20例（16.67%）发生卵巢功能早衰,对照组有15例（11.11%）发生卵巢功能早衰,具有统计学差异。与对照组相比,手术组发生卵巢衰竭的HR值1.92（95%CI 1.29~2.86,P〈0.01）,其中单纯子宫切除的患者发生卵巢衰竭的HR值1.74（95%CI 1.14~2.65,P〈0.05）,全子宫并附带单侧卵巢切除的妇女发生卵巢早衰的HR值2.93（95%CI 1.57~5.49,P〈0.01）。结论：绝经前子宫切除可能增加发生卵巢功能早衰的风险,但其导致卵巢功能早衰的原因尚不明确,手术或子宫基础疾病均可能参与了卵巢功能早衰的发生。

Objective： To assess the risk of earlier ovarian failure in patients who had hysterectomy, by comparing the ovarian functions between the hysterectomy group （ females who had hysterectomy but ovaries retained） and the control group. Methods： The observed women all came from department of Obstetrics and Gynecology of People＇s Liberation Army General Hospital, operation group includ 120 patients undergoing hysterectomy but ovaries retained, and the control group included 135 females without hysterectomy. Serum detections and survey were conducted every year during all of the enrolled patients in a period of 4 years. FSH〉40 U/L was defined as ovarian dysfunction. We used HR to describe the risk of earlier ovarian failure occurance. Statistical analysis was performed using the Cox proportional hazards model. Results： 20 cases in group of undergoing hysterectomy but ovaries retained （16.67%） developed into earlier ovarian failure, while 15 cases （11.11%） in the control group（P〈0.05）. Compared with control group participants, the HR for ovarian failure among the women with hysterectomy as was 1.92 （95% CI 1.29 -2.86, P〈0.01）. The HR for the hysterectomy only women was 1.74 （95% CI 1.14-2.65, P〈0.05）. The HR for the hysterectomy with unilateral oophorectomy was 2.93 （95% CI 1.57-5.49, P〈0.01）. Conclusion： Hysterectomy in premenopausal women may increase the risk of earlier ovarian failure. But the reason of earlier ovarian failure is not clear. The surgery itself or the underlying condition leading to hysterectomy that is the cause of earlier ovarian failure.