子宫保留程度对子宫肌瘤患者术后身心健康的影响

Effects of surgical decision-making based on the situation of uterine preservation during hysterectomy of patients with uterine fibroids on their postoperative physical and psychological health

目的:比较全子宫切除术与次全子宫切除术对子宫肌瘤患者术后身心的影响。方法:选取2019年3月-2024年5月本院收治的子宫肌瘤患者86例,按手术方式分为两组分别行全子宫切除术或次全子宫切除术(全子宫组、次全子宫组)各43例。记录两组术前、术后3个月和6个月时卵巢功能[窦卵泡数、雌二醇(E_(2))、黄体生成素(LH)促卵泡激素(FSH)]、负面心理[焦虑自评量表(SAS)、抑郁自评量表(SDS)、匹茨堡睡眠质量量表(PSQI)、性生活质量[女性性功能指标量表(FSFI)]、是否持续出现术前症状及并发症。结果:术后3个月,次全子宫组窦卵泡数无明显变化(P>0.05),两组血清E_(2)、SAS、SDS、PSQI、性欲望、阴道润滑及性交痛、性唤起及性高潮、性满意度及FSFI总分均降低,LH、FSH、SAS、SDS、PSQI均增高,但全子宫组窦卵泡数、E_(2)、性欲望、阴道润滑及性交痛、性唤起及性高潮、性满意度及FSFI总分均低于次全子宫组,LH和FSH均高于次全子宫组(P<0.05);术后6个月,全子宫组SAS(56.24±2.19分)、SDS(60.34±2.58分)、PSQI(11.95±2.71分)均低于次全子宫组(62.05±2.34分、66.18±3.19分、14.09±2.48分)(P<0.05)。术后并发症全子宫组(11.6%)与次全子宫组(20.9%)无差异(P>0.05)。结论:对存在全子宫切除术指证的子宫肌瘤患者,相比全子宫切除术,次全子宫切除术对患者术后卵巢功能、性生活质量的影响较小,但次全子宫切除术埋下的隐患可能导致负面情绪。临床应根据具体情况与患者共同讨论并帮助患者做出更理性的决定。

Objective:To compare the effects of the total hysterectomy and the subtotal hysterectomy of patients with uterine fibroids on their postoperative physical and psychological health.Methods:86 patients with uterine fibroids admitted to hospital were selected and were divided into two groups(43 cases in each group)based on different hysterectomy method from March 2019 to May 2024.The patients in group A were given total hysterectomy and the patients in group B were given subtotal hysterectomy.The ovarian function,such as the antral follicle count and the levels of serum estradiol(E_(2)),luteinizing hormone(LH)and follicle-stimulating hormone(FSH)before surgery and in 3 and 6 months after surgery,the negative psychology evaluated by self-rating anxiety scale(SAS),self-rating depression scale(SDS),Pittsburgh sleep quality index(PSQI)and female sexual function index(FSFI),the persisted symptoms situation before surgery and the complications rate of the patients in the two groups were recorded.Results:The sinus follicle number of the patients in group B in 3 postoperative months had no significant change(P>0.05).The serum E_(2)level,the scores of SAS,SDS and PSQI,the sexual desire,the situations of the vaginal lubrication and pain,the sexual arousal,the orgasm and the sexual satisfaction during sex,and the FSFI total score of the patients in two groups had decreased significantly,however,the levels of LH and FSH,and the scores of SAS,SDS and PSQI of the patients in two groups had increased significantly.The sinus follicle number,the serum E_(2)level,the sexual desire,the situations of the vaginal lubrication,dyspareunia,sexual arousal,orgasm and satisfaction,and the FSFI total score of the patients in the in group A were significantly lower than those of the patients in group B,and the LH and FSH levels of the patients in group A were significantly higher than those of the patients in group B(P<0.05).The scores of SAS(56.24±2.19points),SDS(60.34±2.58points),PSQI(11.95±2.71points)of the patients in group A in 6months after surgery were significantly lower than those(62.05±2.34points,66.18±3.19points and 14.09±2.48points)of the patients in group B(P<0.05).There was no significant difference in the postoperative complications rate(11.6%vs.20.9%)of the patients between the two groups(P>0.05).Conclusion:For the patients with uterine fibroids who have indications for the hysterectomy,the total hysterectomy of the patients has more impact on the postoperative ovarian function and the sexual quality of life comparing those of the subtotal hysterectomy.However,the hidden dangers of the subtotal hysterectomy maybe lead to the negative emotions of the patients.It is recommended that the discuss with the patients before surgery to help them make a more rational decision in clinic.