不同手术方式对子宫肌瘤患者内分泌状态的影响

Efficacy comparison on the endocrine status of uterine fibroids cystectomy,hysterectomy and partial hysterectomy in uterine fibroids patients

目的探讨和比较子宫肌瘤剥除术、子宫全切术及部分切除术对子宫肌瘤患者内分泌状态的影响。方法选取2010年6月至2014年6月间接受手术治疗的未绝经子宫肌瘤患者85例,按照不同手术方式分为子宫肌瘤剥除术组(32例)、子宫全切组(25例)和子宫部分切除组(28例),观察患者术前及术后6个月时性激素水平的变化。结果术后6个月,子宫肌瘤剥除组患者的卵泡刺激素(FSH)、孕激素(P)、雌二醇(E_2)和黄体成素(LH)水平较术前无明显变化(P>0.05);子宫全切组患者的P、FSH、LH水平显著高于术前(P<0.01),E_2水平显著低于术前(P<0.01);子宫部分切除组患者的P、FSH、LH水平较术前显著增加(P<0.05),E_2水平较术前显著降低(P<0.05)。年龄≤40岁的患者,性激素水平手术前后的差异无统计学意义(P>0.05);年龄>40岁的患者,子宫肌瘤剥除组手术前后性激素水平差异无统计学意义(P>0.05);子宫全切组患者的术后性激素水平较术前有明显差异(P<0.01);子宫部分切除组患者术后性激素水平变化较术前有统计学差异(P<0.05)。围绝经期综合征方面,子宫肌瘤剥除组(9.4%)显著低于子宫全切组(84.0%,P<0.01)、子宫部分切除组(25.0%,P<0.05)。结论不同术式对子宫肌瘤患者的内分泌状态影响不同,对不同年龄患者内分泌状态的影响也存在差异,应根据患者的具体情况谨慎选择手术方式。子宫肌瘤剥除术对患者内分泌影响作用较小,值得临床推广。

Objective To compare the efficacy on the endocrine status of uterine fibroids cystectomy,hysterectomy and partial hysterectomy in uterine fibroids patients. Methods From June 2010 to June2014 in Changcheng Hospital,85 patients with uterine fibroids were enrolled in the study. According to different operation methods,they were divided into uterine fibroids cystectomy group（ 32 cases）,hysterectomy group（ 25 cases） and partial hysterectomy group（ 28 cases）. Variability hormone levels before and 6 mo after operation were compared. Results 6 mo after the operation,follicle stimulating hormone（ FSH）,progesterone（ P）,estradiol（ E_2） and luteinizing hormone（ LH） in uterine fibroids cystectomy group showed no significant difference（ P〈0. 05）; the levels of P,FSH and LH of the hysterectomy group were higher than before（ P〈0. 01）,while the level of E_2 was lower than before（ P〈0. 01）; the levels of P,FSH and LH of the partial hysterectomy group increased significantly（ P〈0. 05）,while the level of E_2 reduced significantly（ P〈0. 05）. Variability of hormone levels before and 6 mo after operation showed no significant difference（ P〉0. 05） for patients with aging ≤ 40 yr. For patients with aging 40 yr,the levels of P,FSH,LH,E_2 in uterine fibroids cystectomy group showed no significant difference（ P〈0. 05） before and after operation; Sex hormone levels of the hysterectomy group showed significant difference（ P〈0. 01）; Sex hormone levels of the partial hysterectomy group showed statistical difference（ P〈0. 05）. On the perimenopausal symptoms,the rate of uterine fibroids cystectomy group（ 9. 4%） was significantly lower than that of hysterectomy group（ 84. 0%,P〈0. 01） and partial hysterectomy group（ 25. 0%,P〈0. 05）. Conclusions The efficacy of different surgical on the endocrine status in patients with uterine fibroids was different,as well as on patients with different ages. The right way of surgery method should be chosen based on patients＇ individual circumstances. Uterine fibroids cystectomy causes less effects on the endocrine status and it is worthy of clinical application.