两种子宫次全切除术对卵巢功能影响的比较

Comparison of the Effects of Two Types of Subtotal Hysterectomy on Ovarian Function

目的:探讨保留血管的子宫次全切除术与传统的子宫次全切除术对患者卵巢功能的影响。方法:将有手术指征的子宫肌瘤患者82例随机分成两组,42例行保留血管的子宫次全切除术(保留组);40例行传统子宫次全切除术(对照组)。术前及术后1、3、6、12、24个月检测所有患者的促卵泡激素(follicle stimulating hormone,FSH)、黄体生成素(luteinizing hormone,LH)、血清雌激素(serum estrogen 2,E2)水平,记录绝经综合征的发生情况,同时采用经阴道彩色多普勒超声监测卵巢血流阻力指数(resistance index,RI)。结果:保留组术后E2、FSH、LH水平稳定,RI水平平稳;对照组术后1个月E2开始下降,术后3个月FSH、LH较术前明显升高,差异均有统计学意义(P<0.01),随着术后时间的延长E2水平持续下降,FSH、LH水平升高更加明显(P<0.05或P<0.01),卵巢血流RI明显升高(P<0.01)。保留组患者术后12、24个月的绝经综合征发生率分别为2.4%、7.1%,对照组分别为25.0%、40.0%,两组比较差异有统计学意义(P<0.05)。结论:保留血管的次全子宫切除术能较大限度地保存患者的卵巢功能,是子宫切除的一个较好的术式。

Objective：To evaluate the effects of blood-vessel-reserved subtotal hysterectomy and traditional subtotal hysterec- tomy on ovarian function. Methods：Eighty-two patients underwent subtotal hysterectomy due to uterine myoma were randomly divided into two groups. Forty-two patients underwent blood-vessel-reserved subtotal hysterectomy （study group）, while forty patients underwent traditional subtotal hysterectomy （control group）. Menopause symptoms were recorded and blood samples were tested for hormone levels, including serum estrogen 2（E2）, follicle stimulating hormone （FSH） and luteinizing hormone （LH） before operation and 1, 3,6,12,24 months after operation. The ovarian arterial resistance index （RI） was measured by Doppler ultrasound. Results： FSH and LH levels in the control group were significantly higher than the study group at 3 months after operation,while E2 level in the control group was significantly lower than the study group at one month after oper- ation. The ovarian blood flow RI and the incidence of menopausal syndrome-related symptoms were significantly higher in the control group than those in the study group. Conclusions： The blood-vessel reserved subtotal hysterectomy can preserve the ovarian function to a large extent and is a better choice for patients underwent subtotal hysterectomy.