子宫切除术同时行双侧输卵管切除对卵巢功能的影响

Influence of hysterectomy and bilateral salpingectomy on ovarian function

目的探讨全子宫切除术同时行双侧输卵管切除对卵巢功能的影响。方法选取陕西省妇幼保健院及安康市汉滨区第一医院2011年1月至2012年6月因子宫良性病变需实施子宫切除术的患者262例,其中全子宫加双侧输卵管切除术138例为研究组,仅全子宫切除者124例为对照组,记录两组患者手术时间、术中出血量、术后肛门排气时间及术后住院时间。所有患者于术后1、3、6、12个月门诊随访,详细询问有无围绝经期症状,并行性激素卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)的测定。结果两组患者手术时间、术中出血量、术后排气时间及术后住院天数比较均无统计学差异(t值分别为-0.460、0.316、0.389、0.167,均P>0.05)。两组术前FSH、LH、E2水平比较均无统计学差异(t值分别为-0.575、-0.539、-1.967,均P>0.05)。研究组术后1、3、6、12个月FSH、LH均较术前显著升高(t值分别为-3.679、-7.374、18.181、25.133、-5.688、-13.182、-16.181、-40.089,均P<0.05),对照组术后1、3、6、12月FSH、LH均较术前显著升高(t值分别为-4.479、-12.833、-13.202、-22.363、-5.600、-9.972、-17.369、-34.448,均P<0.05),两组术后1、3、6、12个月E_2均较术前显著下降(t值分另为2.243、3.087、3.679、5.068、1.999、5.169、9.634、11.183,均P<0.05),而两组间术后1、3、6、12个月FSH、LH、E'水平比较无显著性差异(t值分别为-1.627、-3.945、2.114、3.458、-1.750、0.207、0.528、0.622、-2.911、0.356、3.567、4.913,均P>0.05)。患者术后各随访时间段均有不同程度的围绝经期症状发生率,但两组比较无统计学差异(,值分别为17.411、163.622、89.321、42.110,均P>0.05)。结论子宫全切术会影响卵巢储备功能,但术中同时切除双侧输卵管并不加剧这种影响。故行子宫全切术同时切除外观正常的榆卵管,可预防输卵管癌及卵巢癌的发生。尤其对于有卵巢癌的高危因素或家族史的患者,建议常规切除。

Objective To explore the influence of hysterectomy and bilateral salpingectomy on ovarian function.Methods During January 2011 to June 2012 262 patients needing hysterectomy because of uterine benign disease in Shaanxi Province Maternity and Child Care Hospital and First Hospital of Hanbin District in Ankang City were selected in the study, including 138 cases who underwent hysterectomy and bilateral salpingectomy in study group and 124 cases who underwent hysterectomy alone in control group.Their operation time, intraoperative hemorrhage, postoperative exhaust time and postoperation hospitalization duration were recorded.All patients were followed up after 1, 3, 6 and 12 months, and they were asked whether they had perimenopausal syndrome.Meanwhile their serum sex hormone levels were tested including FSH, LH and E2 .Results There were no statistical differences between two groups in operation time, intraoperative hemorrhage, postoperative exhaust time and postoperation hospitalization duration （t value was -0.460, 0.316, 0.389 and 0.167, respectively, all P〉0.05）.Preoperative FSH, LH and E2 levels of two groups showed no significant differences（t value was-0.575, -0.539 and -1.967, respectively, all P〉0.05）.Both FSH and LH levels of the study group rose after 1, 3, 6 and 12 months（t value was -3.679, -7.374, 18.181, 25.133, -5.688, -13.182, -16.181 and -40.089, respectively, all P〈0.05）, and those of the control group rose too（t value was -4.479, -12.833, -13.202, -22.363,-5.600, -9.972, -17.369 and-34.448, respectively, all P〈0.05）.But E2 levels of two groups decreased （t value was 2.243, 3.087, 3.679, 5.068, 1.999, 5.169, 9.634 and 11.183, respectively, all P〈0.05）.There were no statistical significances between two groups in FSH, LH and E2 levels 1, 3, 6 and 12 months after operation （ t value was -1.627, -3.945, 2.114, 3.458, -1.750, 0.207, 0.528, 0.62, -2.911, 0.356, 3.567, 4.913.all P 〉0.05）.Both groups had incidence of perimenopausal symptoms during follow -up periods, but the difference was not significant （χ^2 value was 17.411, 163.622, 89.321 and 42.110, respectively, all P 〉0.05 ） .Conclusion Hysterectomy has influence on ovarian function, but resection of bilateral oviducts at the same time will not aggravate the effect.As a result, hysterectomy plus resection of the oviducts which are normal in appearance can prevent the happening of carcinoma of the fallopian tubes and ovarian tumors.Conventional resection is recommended especially for the patients who have risk factors or family history of ovarian tumors.