腹腔镜全子宫切除术与次全子宫切除术对子宫肌瘤患者卵巢功能及性生活质量的影响

Effects of laparoscopic total vuersus subtotal hysterectomy on ovarian function and sexual life quality of patients with uterine myoma

目的探讨腹腔镜全子宫切除术与次全子宫切除术对子宫肌瘤（UM）患者卵巢功能及性生活质量的影响。方法选取2013年5月至2016年7月本院收治的84例UM患者，根据不同术式分组，各42例。A组行腹腔镜次全子宫切除术，B组行腹腔镜全子宫切除术，且术后均随访3个月。对比两组手术一般情况及术后恢复情况、手术前及手术后72 h免疫功能指标[T淋巴细胞亚群（CD3＋、CD4＋、CD4＋/CD8＋）]水平、手术前及术后3个月卵巢功能指标[雌激素（E2）、卵泡刺激素（FSH）、窦卵泡数（AFC）]水平、负性情绪[焦虑（HAMA）、抑郁（HAMD）]评分及性生活质量（FSFI）评分。结果手术及恢复情况：与B组比较，A组手术时间、肛门排气时间、住院时间短，术中出血量少，差异均有统计学意义（均P〈0.05）；免疫功能：术前，两组CD3＋、CD4＋及CD4＋/CD8＋水平比较差异均无统计学意义（均P〉0.05），术后72 h，两组免疫功能各指标均有所下降，但A组变化幅度小于B组，差异均有统计学意义（均P〈0.05）；卵巢功能：术前，两组E2、FSH水平及AFC计数比较差异均无统计学意义（均P〉0.05），术后3个月，两组E2均下降，FSH均上升，AFC计数均减少，但A组变化幅度小于B组，差异均有统计学意义（均P〈0.05）；负性情绪：术前，两组HAMA、HAMD负性情绪评分比较差异均无统计学意义（均P〉0.05），术后3个月，A组负性情绪评分低于B组，差异均有统计学意义（均P〈0.05）；性生活质量：术前，两组性生活质量评分比较差异无统计学意义（P〉0.05），术后3个月，A组性生活质量评分高于B组，差异有统计学意义（P〈0.05）。结论腹腔镜子宫切除术会对患者卵巢功能、免疫功能产生一定影响，但腹腔镜次全子宫切除术相比于全子宫切除术影响较小，且前者更利于缓解患者负性情绪，改善性生活质量。

ObjectiveTo investigate the effects of laparoscopic total versus subtotal hysterectomy on ovarian function and sexual life quality of patients with uterine myoma （UM）. Methods84 patients with UM treated at our hospital from May, 2013 to July, 2016 were selected and divided into group A and group B, 42 for each group. Group A underwent laparoscopic subtotal hysterectomy and Group B underwent laparoscopic hysterectomy. All the patients were followed up 3 months. The general situation and postoperative recovery were compared between the two groups. The immune function [T lymphocyte subsets （CD3＋, CD4＋, CD4＋/CD8＋）] levels before and 72 h after operation, ovarian function indicators [estrogen （E2）, follicle stimulating hormone （FSH）, the number of antral follicles （AFC）] before and 3 months after operation, the scores of anxiety （HAMA）, depression （HAMD）, and sexual quality of life （FSFI） were compared between these two groups. ResultsThe operation time, anal exhaustion time, and hospitalization time were shorter and the intraoperative bleeding volume was lower in group A than in group B, with statistical differences （all P〈0.05）. There were no statistical differences in the levels of CD3＋, CD4＋, and CD4＋/CD8＋ between these two groups before operation （P 〉 0.05）; the levels of CD3＋, CD4＋, and CD4＋/CD8＋ were lower 72 h after than before operation in both groups and changed less in group A than in group B 72 h after operation, with statistical differences （all P〈0.05）. There were no statistical differences in the levels of E2 and FSH and AFC counting between these two group before operation; 3 months after operation, the level of E2 decreased, the level of FSH increased, and AFC counting lessened in both group and all the three changed less in group A than in group B, with statistical differences （all P〈0.05）. There were no statistical differences in the scores of HAMA, HAMD, and FSFI between these two group before operation; 3 months after operation, the scores of HAMA and HAMD were lower and the score of FSFI was higher in group A than in group B, with statistical differences （all P〈0.05）. ConclusionsLaparoscopic hysterectomy has certain impact on patients’ ovarian function and immune function; but compared with laparoscopic total hysterectomy, laparoscopic subtotal hysterectomy has less impact, and the former is more conducive to ease the patients’ negative emotions and improve the sexual quality of life.