腹腔镜下子宫次全切除术并输卵管切除对女性卵巢功能的影响

Effect of Laparoscopic Subtotal Hysterectomy with Bilateral Salpingectomy on Ovarian Function in Women

目的:探讨腹腔镜下子宫次全切除术中切除双侧输卵管对卵巢功能及围绝经期症状的影响。方法:选取本院妇科2015年1月-2016年12月因子宫良性病变行腹腔镜下子宫次全切除术的患者120例,按照随机数字表法将其分为观察组和对照组。观察组60例行腹腔镜子宫次全切除术+双侧输卵管切除术,对照组60例仅行腹腔镜子宫次全切除术。比较两组术前、术中及术后情况。两组均随诊12个月,分别测定两组术前及术后3、6、12个月血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E_2)水平,采用改良Kupperman评分评估围绝经期症状发生情况,以评价患者卵巢功能变化。结果:两组手术时间、术中出血量、术后肛门排气时间及住院天数比较,差异均无统计学意义(P>0.05)。两组术前及术后3、6、12个月同期的血清FSH、LH、E_2水平以及改良Kupperman评分比较,差异均无统计学意义(P>0.05);与术前比较,两组患者术后3、6、12个月,血清FSH、LH明显升高、E_2降低,改良Kupperman评分逐渐升高,差异均有统计学意义(P<0.05)。结论:腹腔镜下子宫次全切除术中切除双侧输卵管,不会增加对卵巢近期功能的影响,不加重围绝经期症状,值得临床推广。

Objective：To investigate the effect of bilateral salpingectomy in laparoscopic subtotal hysterectomy on ovarian function and perimenopausal symptoms.Method：A total of 120 patients with uterine benign tumors who had undergone laparoscopic subtotal hysterectomy in Department of Gynaecology our hospital from January 2015 to December 2016 were selected.According to the random number table method,they were divided into observation group and the control group.60 patients in the observation group were received laparoscopic subtotal hysterectomy with bilateral salpingectomy,60 patients in the control group were only received laparoscopic subtotal hysterectomy.Preoperative,intraoperative and postoperative conditions between the two groups were compared.The two groups were followed up for 12 months,the levels of serum follicule stimulating hormone（FSH）,luteinizing hormone（LH）and estradiol（E2） were measured before and 3,6,12 months after operation,modified Kupperman score was used to evaluate the occurrence of perimenopausal symptoms in order to evaluate the changes of ovarian function.Result：There were no significant differences in the operation time,intraoperative blood loss,postoperative anus exhaust time and length of hospital stay between the two groups（P〈0.05）.There were no significant differences in the levels of FSH,LH,E2 and modified Kupperman score between the two groups before and 3,6,12 months after operation.At 3,6,and 12 months after operation,the serum FSH and LH were significantly higher,E2 was significantly lower and the modified Kupperman score was gradually higher than those before operation in two groups,the differences were statistically significant（P〈0.05）.Conclusion：Laparoscopic subtotal hysterectomy with bilateral salpingectomy does not increase the short-term function of the ovary,and does not aggravate the perimenopausal symptoms,which is worthy of clinical promotion.