子宫全切时输卵管不同处理方式对卵巢功能影响的研究

Study on the Effect of Fallopian Tube on Ovarian Function During Total Hysterectomy

目的研究非绝经期女性因子宫良性疾病行腹腔镜下子宫全切时是否切除及不同方式切除双侧输卵管术后对其卵巢功能的影响。方法选取2016年8—12月在潍坊医学院附属医院因子宫良性疾病行腹腔镜下全子宫切除术的非绝经期女性45例作为研究对象。将其随机分为A组、B组、C组,每组各15例,分别采用单纯全子宫切除、同时传统法切除输卵管、同时抽芯法切除输卵管,随访至术后6个月。结果 (1)三组术前血清AMH水平、Kupperman评分比较,差异无统计学意义(P> 0.05)。(2)三组术后1个月及6个月血清AMH均较术前下降,差异均具有统计学意义(P <0.05);术后1个月AMH组间比较,仅B组与A组比较,差异有统计学意义(P <0.05);术后6个月血清AMH组间两两比较,差异均不具有统计学意义(P> 0.05)。(3)术后1个月及术后6个月围绝经期症状发生率B组高于C组及A组,但组间比较,差异无统计学意义(P> 0.05);三组术后6个月改良Kupperman评分均较术前明显升高,差异均具有统计学意义(P <0.05),但术后1个月较术前及术后同时间点组间两两比较,差异均无统计学意义(P> 0.05)。结论全子宫切除术后血清AMH水平下降,加速卵巢功能的衰竭,但术中是否切除及不同方式切除双侧输卵管,对卵巢功能的影响无差别。

Objective To investigate the effect of non-menopause women on ovarian function after laparoscopic hysterectomy with different treatment of fallopian tubes for benign uterine diseases.Methods A total of 45 nonmenopausal women who underwent laparoscopic hysterectomy for benign uterine diseases in the Affiliated Hospital of Weifang Medical College from August to December 2016 were selected as the study subjects.They were randomly divided into group A,group B and group C,with 15 cases in each group.The patients were followed up to 6 months after operation by simple hysterectomy,traditional tubectomy and coring.Results (1) There was no significant difference in serum AMH level and Kupperman score between the three groups before operation (P>0.05).(2) Serum AMH in the three groups decreased 1 month and 6 months after operation,and the difference was statistically significant (P<0.05).One month after operation,there was significant difference in AMH between group B and group A (P<0.05). There was no significant difference in serum AMH between two groups at 6 months after operation (P>0.05).(3) The incidence of perimenopausal symptoms in group B was higher than that in group C and group A one month and six months after operation,but there was no significant difference between the two groups (P>0.05).The improved Kupperman score of the three groups at 6 months after operation was significantly higher than that before operation,and the difference was statistically significant (P<0.05).However,there was no significant difference between the two groups at the same time point and one month after operation (P > 0.05).Conclusion Serum AMH levels decreased after hysterectomy,which had a negative impact on ovarian function,but whether the resection and different methods of bilateral salpingectomy does not aggravate the decline of ovarian function.