保留子宫动脉的子宫切除术近期临床效果评价  

Evaluation of clinical effect of hysterectomy preserving the uterine artery

作　　者：温菁[1] 王学慧[1] 郭邑[2] 崔慧珠[1] 包洪丽[1] 刘健[1] 马晓秋[1] 

机构地区：[1]大连大学附属中山医院妇产科,116001 [2]大连市妇产医院妇科

出　　处：《中华妇产科杂志》2006年第11期745-748,共4页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨保留子宫动脉上行支及卵巢支的子宫切除术用于临床的可行性，及其对卵巢功能的影响。方法选择2003年9月至2005年2月间，在大连大学附属中山医院妇产科住院的、因妇科良性疾病需要切除子宫而保留卵巢的患者52例（研究组），采用保留子宫动脉的子宫切除术，其中子宫次全切除术35例，子宫全切除术17例；同期采用传统子宫切除术的38例作为对照组；对两组中年龄在36～45岁的患者各30例，分别于术前1个月、术后1、6、12个月，在卵泡中晚期抽取患者静脉血2ml，测定血清雌二醇、卵泡刺激素（FSH）、黄体生成素（LH）、泌乳素水平。并对所有研究组患者在术前、术后1个月进行经阴道彩色多普勒超声（彩超）检查。结果术后1个月经阴道彩超检查证实，研究组52例中，1例双侧子宫动脉未保留，6例单侧未保留；术后双侧子宫动脉平均收缩期血流速度峰值（Va）为（20±9）cm／s，舒张期血流速度峰值（Vb）为（3、8±3．2）cm／s，与术前Va[（29±8）cm／s]、Vb[（7．1±3．4）cm／s]比较，血流减慢（P〈0．01），术后血流阻力指数（RI）为0．79±0．08，与术前RI（0．80±0．08）比较，差异无统计学意义（P〉0．05）；术后6个月时，研究组雌二醇水平为（398±200）pmol／L，对照组为（175±131）pmol／L，两组比较，差异有统计学意义（P〈0．01）；两组手术时间、出血量、术后排气时间等比较，差异均无统计学意义（P〉0．05）。结论保留子宫动脉的子宫切除术用于临床方便、可行，近期可保留卵巢的完整血液供应及功能。Objective To discuss the clinical feasibility of hysterectomy that preserves the ascending branch and the ovarian branch of the uterine artery, and the effect on the ovary. Methods Fiftytwo women who received hysterectomy with preservation of the ovaries, the so called divest due to benign gynecological disease were selected as the study group. It consisted of 35 patients who received subtotal-divest and 17 patients who received total-divest. Meanwhile, 38 cases who received traditional hysterectomy served as the control group. Two milliliter venous blood was taken and estradiol, follicle stimulating hormone （FSH）, luteinizing hormone （LH）, prolactin （PRL） were measured at 1 month preoperation, 1 month, 6 months, and 12 months postoperation from 30 women with age ranging from 36 -45 years of the two groups each. All the patients in the study group received ultrasonography via vagina at 1 month preoperation and postoperation, respectively. Results Postoperatively, through vagina color ultrasound examination, in the 52 cases of study group, bilateral uterine arteries were not retained in 1 case, and unilateral uterine artery was not retained in 6 cases. The postoperative peak blood flow of uterine artery during systolic phase （Va） was （20 ±9 ） cm/s, and during diastolic phase （Vb） was（ 3.8 ± 3.2 ） cm/s. Compared with the preoperative values, （29 ± 8 ） cm/s, （7. 1± 3.4 ） cm/s, the velocity of blood was slowed obviously （ P 〈 0. 01 ）. The postoperative resistance index （RI） （0. 79±0. 08 ）, was not significantly different compared with the preoperative value（0. 80 ±0. 08 ） （ P 〉 0. 05 ）. The operative time, bleeding volume, and the postoperative exhaust time had no significant difference between the two groups（ P 〉 0. 05 ）. Comparing the hormone assay of two groups, there was a significant change at 6 months postoperation in the control group, but postoperation hormone assay had no significant change compared with the pre-operative result in study

关 键 词：子宫切除术 超声检查 多普勒 彩色 性腺甾类激素 

分 类 号：R713[医药卫生—妇产科学]