腹腔镜子宫肌瘤手术方式对卵巢储备功能的影响

Effect of surgical modalities for uterine fibroids on functional reserve of ovarian

目的探讨腹腔镜子宫肌瘤手术方式对卵巢储备功能的影响。方法腹腔镜子宫肌瘤手术患者96例,年龄37-47岁,分别采用全子宫切除术(A组,32例)、次全子宫切除术(B组,31例)和子宫肌瘤剜除术(C组,33例)。于术前、术后1个月和4个月检测血清抗苗勒氏管激素(AMH)、卵泡刺激素(FSH)、促黄体激素(LH)、雌二醇(E_2)和抑制素B(INHB)水平。结果与术前相比,C组术后1个月和4个月血清AMH水平无统计学差异(P>0.05),但A、B两组血清AMH水平均下降(P<0.01)。术后4个月,A组AMH较术前下降比B组更多(P<0.05)。三组手术前后的FSH、LH、E2和INHB水平均无统计学差异(P>0.05)。结论腹腔镜全子宫切除术或次全子宫切除术患者术后AMH均显著下降,提示其对卵巢储备功能有显著影响。

Objective To investigte the effect of laparoscopic surgical modalities for uterine fibroids on functional reserve of the ovarian. Methods A total of 96 patients aged 37 47 years old with uterine fibroids was operated for total laparoscopic hysterectomy （group A, 32 cases）, subtotal hysterectomy（group B, 31 cases） and myomectomy（group C, 33 cases）. Serum levels of anti-Mtillerian hormone（AMH）, follicle-stimulating hormone （FSH）, luteinizing hormone （LH）, estradiol （E2） and inhibin-B were detected before and in the 1st and 4th month after surgery. Results Compared to before,serum levels of AMH in the 1st and 4th month after surgery were not remarkably changed in group C（P〉0. 05）,which were significantly decreaed in groups of A and B（P^0. 01）. Compared to before, serum level of AMH in the 4th month after surgery was decreased more in group A than that in group B（P〈0. 05）. Compared to before, serum levels of FSH, LH, E2 and inhibin-B after operation were not significantly changed in groups of A,B and C（P〉0. 05）. Conclusion Serum levels of AMH are significantly decreased after total or subtotal laparoscopic hysterectomy in the patients with uterine fibroids, which indicates that functional reserve of the ovarian is affected by surgical modalities.