子宫手术不同术式对生育期妇女卵巢功能影响的研究

The influence of uterine surgery on the ovarian function of women during the reproductive period

目的:探讨不同子宫手术方式对生育期妇女卵巢功能的影响。方法:选取因生殖系统疾病行手术治疗的180例生育期女性患者,检测术前、术后6个月的血FSH、E2、AMH,并评估其潮热等更年期症状。结果:术前和术后6个月患者均未出现卵巢功能衰竭。与术前比较,年龄>40岁者术后6个月的AMH显著下降(P<0.05)。子宫肌瘤剔除术的患者术前AMH为(3.54±1.31)ng/ml,术后(3.69±1.35)ng/ml,差异无统计学意义(P=0.612)。与术前比较,子宫次全切除术患者术后AMH降低,但差异无统计学意义;子宫全切术(包括筋膜外子宫全切术)患者的术后AMH显著降低[(1.45±0.68)ng/ml vs(1.80±0.96)ng/ml,P<0.05];广泛性子宫切除术患者的术后AMH显著降低[(2.72±1.08)ng/ml vs(3.31±0.92)ng/ml,P<0.05];腹腔镜下子宫切除术患者的术后AMH显著降低[(1.56±1.00)ng/ml vs(1.94±1.10)ng/ml,P<0.05]。结论:子宫手术短期内不会导致卵巢功能衰竭,年龄、子宫切除方式与途径可能是子宫手术后短期内卵巢储备功能下降的影响因素。

Objective：To observes the influences of uterine surgery on the ovarian function of women during the reproductive period. Methods：Subjects investigated were 180 fe- male patients during the reproductive period, with reproductive system diseases requiring opera- tion treatment. Operation schemes adopted cover various uterine surgery procedures including laparoscope and transabdominal approach, as well as myohysterectomy, supracervical hysterecto- my, total hysterectomy （ including extrafascial hysterectomy） , and radical hysterectomy. FSH, E2, AMH were detected before the operation and redetected together with the symptoms of hot flashes 6 months after the operation. Results： Compared with preoperative detections, no patients experience any symptoms of ovarian failure. AMH in patients over 40 decreased remarkably 6 months after the operation. Little change （P=0. 612） of AMH was detected in patients having received myohysterectomy, with （3.54± 1.31 ） ng/ml before the operation and （ 3.69 ±1.35 ） ng/ml after. A slight decrease （ P = 0. 598） of AMH was detected in patients with supracervical hysterectomy. A significant decrease （ P 〈 0.05 ） of AMH was detected in patients having re- ceived total hysterectomy （ including extrafaseial hysterectomy）, with （ 1.80 ±0.96 ） ng/ml be- fore the operation and （ 1.45 ±0.68 ） ng/ml after. A significant decrease （ P〈0.05 ） of AMH was detected in patients having received radical hysterectomy ,with （3.31±0.92 ）ng/ml before the operation and （2.72±1.08）ng/ml after. A significant decrease （P〈0.05） of AMH was de- tected in patients having received laparoscopic hysterectomy, with （1.94±1.10）ng/ml before the operation and （1.56±1.00） ng/ml after. Conclusion：Uterine surgery won＇t cause ovarian function failure in the short term. Age, hysterectomy procedures and approaches may be the in- fluential factors for a decline in ovarian reserve function in the short term.