子宫肌瘤不同手术方式对卵巢与性功能的影响

Effect of different operation methods on ovarian function and sexual life of patients with uterine myoma

目的分析子宫肌瘤全子宫切除与次全子宫切除术对卵巢与性功能的影响。方法选择2014-08至2016-08诊断症状性子宫肌瘤患者120例,按入院先后以信封法随机分为全子宫切除手术(全子宫组)与次全子宫切除手术(次全子宫组),各60例。两组年龄、病程、子宫大小、肌瘤数目及平均直径比较,差异无统计学意义。比较两组手术时间、术中出血量、术后肠道恢复时间、住院时间、住院费用,以及下肢静脉血栓、阴道感染率差异。分别于术前与术后3、6个月采用放射免疫法检测血清雌二醇(E_2)、促卵泡生成激素(FSH)、促黄体生成激素(LH)水平变化。于术前及术后6个月,采用女性性功能调查问卷指数对两组患者术后性功能进行评估。结果次全子宫组手术时间、术中出血量、术后肠道恢复时间、住院时间、住院费用均少于全子宫组患者,术后下肢静脉血栓、阴道感染率也低于全子宫组,两组比较差异均有统计学意义(P<0.05)。术后3、6个月,次全手术组血清E_2、FSH、LH水平与术前比较波动不明显,全子宫组术后3个月,血清E_2下降,FSH、LH水平轻度升高,6个月恢复正常水平,但不同时间点两组比较差异无统计学意义。全子宫手术组患者性功能评分显著低于次全子宫组,其中,以性交痛、性欲满意度、阴道润滑度指标明显降低,两组比较差异有统计学意义(P<0.01)。结论子宫肌瘤经腹子宫切除术对卵巢功能无明显影响,但子宫全切除术后性生活满意度较低。

Objective To analyze the effect of total hysterectomy and subtotal hysterectomy on ovarian function and sexual life of patients with uterine myoma. Methods Between August 2014 and August 2016,120 cases of patients with symptomatic uterine myoma were selected and randomly and equally divided into total hysterectomy group and subtotal hysterectomy group. There was no significant difference in age,course of disease,duration of disease,uterine size,numbers of uterine myoma and the mean diameter between the two groups（ P〈0. 05）. The operation time,intraoperative blood loss volume,postoperative intestinal recovery time,length of hospital stay,medical expenses,deep vein thrombosis and vaginal infection rate were compared between the two groups. The levels of serum estradiol（ E2）,follicle stimulating hormone（ FSH） and luteinizing hormone（ LH） were analyzed by radioimmunoassay method pre-operativley and three months and six months post-operatively. The indexes of female sexual function questionnaires issued preoperatively and sixth months postoperatively was compared to evaluate the postoperative sexual function in the two groups. Results After operation,all the indexes of the operation time,bleeding volume,postoperative intestinal recovery time,length of hospital stay and medical expenses in the subtotal hysterectomy（ surgical） group were reduced compared with the total hysterectomy group. The rates of deep vein thrombosis and postoperative vaginal infection were also lower than in the total hysterectomy group. There was statistically significant difference between the two groups（ P〈0. 05）. When the pre-operative serum E2,FSH and LH levels in the total hysterectomy（ surgical） group were compared with postoperative ones,the fluctuation was not quite obvious. However,in the total hysterectomy（ surgical） group,the levels of serum E2 decreased,while FSH and LH levels increased slightly and returned to normal after six months,but there was no significant difference between the two groups at different time points（ P〉0. 05）. The uterine function score in the total hysterectomy（ surgical） group was significantly lower than that of subtotal hysterectomy uterus group. Sexual desire,sexual pain,sexual satisfaction and the vaginal lubrication degree index decreased significantly. There was significant difference between the two groups（ P〈0. 003）. Conclusions Abdominal hysterectomy has no significant effect on ovarian function,but the degree of satisfaction with sexual life is lower for patients after abdominal hysterectomy.