腹腔镜全子宫并双侧输卵管切除对绝经后妇女卵巢功能的影响  

Effects of laparoscopic panhysterectomy with bilateral salpingectomy on ovarian function in women with postmenopausal uterine benign tumors

作　　者：陈钢[1] 何红霞[1] 

机构地区：[1]陕西省汉中市中心医院妇科,陕西汉中723000

出　　处：《空军医学杂志》2016年第3期185-188,215,共5页Medical Journal of Air Force

基　　金：陕西省自然科学基金资助项目(2013JM4012)

摘　　要：目的探讨腹腔镜全子宫并双侧输卵管切除对绝经后妇女卵巢功能的影响。方法选取2011年7月—2013年7月汉中市中心医院妇科行腹腔镜全子宫切除术的绝经后子宫良性肿瘤患者145例(含19例脱落病例)作为研究对象,根据是否切除双侧输卵管分组,观察组86例切除双侧输卵管,对照组59例保留双侧输卵管,剔除脱落病例,观察组最终纳入75例,对照组最终纳入51例。记录2组手术时间、术中出血量、住院时间;随访术后24个月,对比手术前、术后3、12、24个月雌二醇(estradiol,E2)、卵泡刺激素(follicle stimulating hormone,FSH)、黄体生成素(luteinizing hormone,LH)、收缩期血流峰值流速(Vmax)、舒张末期最小血流速度(Vmin)、阻力值(resistance value,RI)、搏动指数(pulsatility index,PI)变化,并行改良更年期综合征(Kupper man)评分,记录随访24个月内输卵管病变、盆腔包块及再手术发生率。结果 2组术后12、24个月E2、FSH、LH与术前比较,差异有统计学意义(P<0.05),术后3个月与术前比较,差异无统计学意义(P>0.05);观察组术后12、24个月E2显著低于对照组,FSH、LH显著高于对照组(P<0.05)。2组术后Vmax、Vmin显著下降,RI、PI显著上升,与治疗前相比差异有统计学意义(P<0.05),但2组间术前及术后3、12、24个月各时间点对比,差异无统计学意义(P>0.05)。观察组随访末期Kupperman评分显著高于对照组,差异有统计学意义(P<0.05)。观察组术后输卵管病变、盆腔包块发生率分别为0、5.33%,显著低于对照组的19.61%、17.65%,差异有统计学意义(P<0.05)。结论腹腔镜全子宫并双侧输卵管切除对卵巢功能有不良影响,会加重绝经后症状,但可降低术后输卵管病变、盆腔包块发生率。Objective To investigate the effect of bilateral salpingectomy in laparoscopic panhysterectomy on women with postmenopausal uterine benign tumors. Methods 145 cases （including 19 off cases） of patients with postmenopausal uterine benign tumors who had undergone laparoscopic panhysterectomy in the Department of Gynaecology between July 2011 and July 2013 were selected as the subjects. According to whether the bilateral fallopian tubes were removed, the patients were grouped. 86 cases in the observation group received bilateral salpingectomy while 59 cases in the control group did not. Excluding off cases, there were 75 cases in the observation group and 51 cases in the control group finally. The operation time, intraoperative blood loss and length of hospital stay of the two groups were recorded. After postoperative 24 months of follow-up, the changes of estradiol （E2）, follicle stimulating hormone （FSH）, luteinizing hormone （LH）, systolic peak velocity （Vmax）, end-diastolic minimal velocity （Vmin）, resistance value （RI） and pulsatility indexes （PI） before operation and at 3, 12 and 24 months after operation were compared. The modified menopausal syndrome （Kupperman） score was performed. The incidence of fallopian tube lesions, pelvic masses and reoperation within 24 months of follow-up was recorded. Results 12 and 24 months after operation, E2, FSH and LH in the two groups were significantly different from those before operation （P〈0.05）. There was no significant difference （P〉0.05） compared with those at 3 months after operation, At 12 and 24 months after operation, E2 in the observation group was significantly lower than that in the control group while FSH and LH were significantly higher （P〈0.05）. After operation, Vmin and Vmax of the two groups decreased significantly while PI and RI increased significantly. Compared with those before treatment, there were significant differences （P〈0.05）. However, compared with those before operation, 3, 12, 24 mont

关 键 词：子宫良性肿瘤 腹腔镜 全子宫切除术 双侧输卵管切除术 卵巢功能 

分 类 号：R713[医药卫生—妇产科学]