绝经前行子宫及双侧输卵管切除对子宫肌瘤患者卵巢储备功能的影响

Influence of hysterectomy and bilateral salpingectomy on ovarian function in premenopausal patients with uterine fibroids

目的 探讨绝经前行子宫及双侧输卵管切除对子宫肌瘤患者卵巢储备功能的影响.方法 选取2010年1月至2014年4月年龄40 ～ 50岁的未绝经行子宫及双侧输卵管切除的子宫肌瘤患者120例作为研究组,另选取周期年龄40 ～52岁的有子宫的绝经前妇女120名作为对照组.比较2组更年期症状的发生率;对研究组患者分别在术前、术后3和6个月观察卵巢血流和卵巢功能的变化;比较研究组术前、术后3和6个月卵泡刺激素（FSH）、黄体生成素（LH）、雌二醇、孕酮、血脂及性激素水平.结果 研究组有90例（75.0％）至少有1种更年期症状,其中58例发生在术后1年内,这其中30例发生于术后1个月内;32例发生在第2年以后.对照组有54例（45.0％）至少有1种更年期症状.2组更年期症状发生率比较,差异有统计学意义（P＜0.05）.研究组有98例检测到卵巢血流,术后3、6个月阻力指数及搏动指数明显高于术前,差异有统计学意义[（0.61±0.20）、（0.64±0.08）比（0.52±0.11）;（0.75±0.09）、（0.77±0.11）比（0.60±0.08）]（P＜0.05）.研究组患者术后3、6个月总胆固醇、低密度脂蛋白胆固醇水平均高于术前[（5.72±0.05）、（5.71±0.03） mmol/L比（5.45±0.07） mmol/L、（3.391 ±0.062）、（3.532±0.043） mmol/L比（3.155 ±0.022）mmol/L],而高密度脂蛋白胆固醇水平均低于术前[（1.001 ±0.023）、（0.923±0.032） mmol/L比（1.094±0.071） mmol/L],差异均有统计学意义（均P＜0.05）;术后6个月三酰甘油水平高于术前[（1.72 ±0.05） mmol/L比（1.65±0.07） mmol/L],差异有统计学意义（P＜0.05）.研究组患者术后3、6个月FSH水平明显高于术前[（30±4）、（44±3）IU/L比（14 ±5） IU/L],雌二醇和孕酮水平明显低于术前[（97.4±1.0）、（60.8±1.3） pmol/L比（127.3±1.2） pmol/L,（6.6±2.9）、（2.9±1.7）nmol/L比（10.3-±3.0）nmol/L],差异有统计学意义（P＜0.05）,手术前后睾酮水平比较,差异无统计学意义（P＞0.05）.结论 子宫及双侧输卵管切除术可影响子宫肌瘤患者血流及卵巢的内分泌功能,在临床中应加强术后随访.

Objective To explore the influence of hysterectomy and bilateral salpingectomy on ovarian function in premenopausal patients with uterine fibroids.Methods Totally 120 premenopausal patients of 40-50 years old with uterine fibroids who underwent hysterectomy and bilateral salpingectomy were enrolled as observation group; 120 premenopausal women of 40-52 having uterine were selected as control group.The incidences of menopause symptoms were compared between the two groups.Before operation and 3 and 6 months after operation,the changes of ovarian blood flow and ovarian function were observed,and the follicle-stimulating hormone （FSH）,luteinizing hormone （LH）,estradiol,progesterone,blood lipids and sex hormone levels were measured.Results Totally 90 patients （75.0%） in observation group had at least one kind of menopausal symptoms; the menopausal symptoms occurred within 1 year after surgery in 58 cases; it occurred within 1 mouths after operation in 30 cases and 2 years after operation in 32 cases.Totally 54 subjects （45.0%） in control group had at least one kind of menopausal symptoms,lower than that in observation group （P 〈 0.05）.There were 98 cases of ovarian blood flow detected 3 and 6 months after surgery ; among them the resistance index and pulsatility index were both significantly higher than those before operation [（0.61 ±0.20）,（0.64 ±0.08） vs （0.52 ± 0.11） ; （0.75 ±0.09）,（0.77 ±0.11） vs （0.60 ±0.08）] （P 〈0.05）.Three and 6 months after operation,the total cholesterol,low-density lipoprotein cholesterol were significantly higher than those before operation [（5.72±0.05）,（5.71 ±0.03） mmol/L vs （5.45 ±0.07） mmol/L,（3.391 ±0.062）,（3.532 ± 0.043） mmol/L vs （3.155 ± 0.022） mmol/L] ; high-density lipoprotein cholesterol was significantly lower than that beforesurgery [（1.001 ±0.023）,（0.923 ±0.032） mmol/L vs （1.094±0.071） mmol/L],and the differences were statistically significant （P 〈 0.05） ; 6 months t after operation,the triacylglycerol was significantly higher than that before surgery [（1.72 ±0.05） mmol/L vs （1.65 ± 0.07） mmol/L],differences was statistically significant （P 〈 0.05）.The FSH in observation group was significantly higher than that before surgery 3 and 6 months after operation [（30 ±4）,（44 ±3） IU/L vs （14 ±5） IU/L] ; the estradiol and progesterone levels were significantly lower than those hefore surgery [（97.4 ± 1.0）,（60.8 ± 1.3） pmol/L vs （127.3 ± 1.2） pmol/L,（6.6 ± 2.9）,（2.9 ± 1.7） nmol/L vs （10.3 ± 3.0） nmol/L],and the differences were statistically significant （P 〈0.05）.The testosterone level had no significant changes after operation in observation group （P 〉 0.05）.Conclusion Hysterectomy and bilateral salpingectomy in patients with uterine fibroids can affect the ovarian hemodynamic and endocrine function.