腹腔镜全子宫切除术联合预防性双侧输卵管切除术对疗效和卵巢功能的影响

Effect of laparoscopically total hysterectomy combined with preventive bilateral Fallopian tube resection on curative effect and ovarian function

目的探讨腹腔镜下行全子宫切除术的同时联合预防性行双侧输卵管切除术对手术疗效和卵巢功能的影响。方法选取2014年2月-2018年6月在广州市番禺区中心医院接受腹腔镜子宫切除术的84例患者作为研究对象,分为子宫组45例,仅接受腹腔镜下全子宫切除术;子宫+输卵管组39例,接受腹腔镜下全子宫切除联合双侧输卵管切除术。比较两组患者手术时间、术中出血量以及术后肛门排气时间、住院时间及术后并发症等;比较患者入院时及术后3个月的黄体生成素(LH)、卵泡刺激素(FSH)和雌二醇(E2),运用Kupperman评分评价患者术后围绝经期的症状并进行两组间比较。结果两组患者的手术时间[(90.47±21.27)min vs.(92.84±18.37)min]、术中出血量[(56.82±12.35)ml vs.(58.51±14.73)ml]、排气时间[(16.79±3.42)h vs.(16.03±5.46)h]、住院时间[(4.53±1.23)d vs.(4.49±0.92)d]及术后并发症的发生率(下腹隐痛:6.67%vs. 2.56%,尿潴留:6.67%vs. 3.33%,发热:11.11%vs. 15.38%)比较,差异均无统计学意义(t=0.542、0.572、0.775及0.167,χ^(2)=0.775、0.088及0.335,均P>0.05)。两组患者的术后LH和FSH[子宫组:(12.46±3.12)mIU/ml、(14.52±3.27)mIU/ml,子宫子宫+输卵管组:(12.94±4.36)mIU/ml、(14.37±4.09)mIU/ml]均较术前[子宫组:(8.85±2.17)mIU/ml、(8.94±1.94)mIU/ml,子宫子宫+输卵管组:(8.80±1.98)mIU/ml、(8.64±2.17)mIU/ml]有显著提高,而E_(2)[子宫组(320.37±45.47)pmol/L,子宫子宫+输卵管组(302.37±34.57)pmol/L]水平较术前[子宫组(472.31±56.73)pmol/L,子宫子宫+输卵管组(469.37±60.29)pmol/L]显著下降,差异均有统计学意义(均P<0.05)。而两组患者术后的Kupperman评分和MENQOL评分[子宫组:(4.52±1.23)分、(60.15±9.11)分,子宫子宫+输卵管组:(4.49±1.72)分、(64.50±10.55)分]也较术前[子宫组:(1.09±0.12)分、(41.70±7.89)分,子宫子宫+输卵管组:(1.11±0.15)分、(45.70±7.58)分]有明显上升,差异有统计学意义(P<0.05)。术后两组间的LH、FSH、Kupperman评分及MENQOL评分比较,差异均无统计学意义(t=0.586、0.187、0.093及37.213,均P>0.05),但子宫+输卵管组术后的E2水平显著低于子宫组,差异有统计学意义(t=2.017,P<0.05)。结论对于接受腹腔镜下行全子宫切除术的患者,预防性行双侧输卵管切除术并不会显著加重卵巢功能的衰退,因此在临床上具有应用价值。

Objective To explore the effect of laparoscopically total hysterectomy combined with preventive bilateral Fallopian tube resection on curative effect and ovarian function.Methods From February 2014 to June 2018, 84 patients undergoing laparoscopically total hysterectomy in Central Hospital of Panyu District, Guangzhou were selected and divided into uterus group(45 patients, laparoscopically total hysterectomy) and uterus+Fallopian tube group(45 patients, laparoscopically total hysterectomy combined with preventive bilateral Fallopian tube resection). The operation time, the amounts of blood loss during operation, postoperative anus exhausting time, hospitalization time, and complications in the two groups were compared;the levels of luteinizing hormone(LH), follicle-stimulating hormone(FSH), and estradiol(E;) at admission and at three months after operation were compared, Kupperman score was used to evaluate the perimenopausal symptoms after operation.Results There was no statistically significant difference in operation time [(90.47±21.27) minutes versus.(92.84±18.37) minutes], the amount of blood loss during operation [(56.82±12.35) ml versus(58.51±14.73) ml], postoperative anus exhausting time [(16.79±3.42) hours versus(16.03±5.46) hours], hospitalization time [(4.53±1.23) days versus(4.49±0.92) days], and incidence rate of complications(a dull ache in the lower abdomen: 6.67% versus 2.56%;urinary retention: 6.67% versus 3.33%;fever: 11.11% versus 15.38%) between the two groups(t=0.542, 0.572, 0.775, 0.167, χ^(2)=0.775, 0.088, 0.335, all P>0.05). After operation, the levels of LH and FSH in the two groups [uterus group:(12.46±3.12) mIU/ml,(14.52±3.27) mIU/ml;uterus+Fallopian tube group:(12.94±4.36) mIU/ml,(14.37±4.09) mIU/ml] were significantly higher than those before operation [uterus group:(8.85±2.17) mIU/ml,(8.94±1.94) mIU/ml;uterus+Fallopian tube group:(8.80±1.98) mIU/ml,(8.64±2.17) mIU/ml], while the levels of E;[uterus group:(320.37±45.47) pmol/L;uterus+Fallopian tube group:(302.37±34.57) pmol/L]were significantly lower than those before operation [uterus group:(472.31±56.73) pmol/L;uterus+Fallopian tube group:(469.37±60.29) pmol/L](P<0.05), Kupperman scores and MENQOL scores in the two groups [uterus group:(4.52±1.23),(60.15±9.11);uterus+Fallopian tube group:(4.49±1.72),(64.50±10.55)] were significantly higher than those before operation [uterus group:(1.09±0.12),(41.70±7.89);uterus+Fallopian tube group:(1.11±0.15),(45.70±7.58)](P<0.05). After operation, there was no statistically significant difference in the levels of LH and FSH, Kupperman score and MENQOL score between the two groups(t=0.586, 0.187, 0.093, 37.213, all P>0.05), the level of E;after operation in uterus+Fallopian tube group was statistically significantly lower than that in uterus group(t=2.017, P<0.05).Conclusion For the patients undergoing laparoscopically total hysterectomy, preventive bilateral Fallopian tube resection will not aggravate the decline of ovarian function, which is worthy of clinical application.