全子宫及双侧输卵管切除对术后卵巢功能的近期影响  

Short-term influence on ovarian reserve in premenopausal women with hysterectomy plus salpingectomy

作　　者：陈翠莹[1] 游可理[2] 陈观娣[2] 吴淑燕[2] 李志刚[1] 

机构地区：[1]南方医科大学研究生学院,广州医学硕士研究生510515 [2]广东省人民医院广东省医学科学院妇产科,广州510080

出　　处：《医学研究生学报》2017年第1期83-87,共5页Journal of Medical Postgraduates

摘　　要：目的在行全子宫切除术的同时,预防性(或机会性)切除双侧输卵管可降低患卵巢/盆腔浆液性癌的风险。文中探讨绝经前女性因子宫良性疾病行腹腔镜下全子宫切除同时预防性切除双侧输卵管对卵巢功能的近期影响。方法回顾性分析广东省人民医院妇科2014年10月至2015年10月期间因子宫良性疾病行腹腔镜下子宫全切除术的60例绝经前女性患者。其中术中同时行双侧输卵管切除术(观察组)与保留双侧输卵管(对照组)患者各30例。比较2组患者术前、术后1个月以及3个月的卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、抗苗勒管激素(AMH)水平变化以及围绝经期症状发生率。结果 2组患者年龄、孕产次、月经周期、手术指征、合并症、既往腹部手术史等临床基线资料差异无统计学意义(P>0.05)。观察组与对照组术前、术后1个月以及3个月的AMH分别为(1.08±0.08)和(1.04±0.10)ng/m L、(0.86±0.44)和(0.81±0.48)ng/m L、(0.84±0.94)和(0.68±0.42)ng/m L,差异无统计学意义(F=0.247,P=0.746);与术前AMH水平比较,术后1个月以及3个月均明显下降(P<0.05);而术后1个月和3个月的AMH水平差异无统计学意义(P>0.05)。2组间FSH、LH及E2水平变化差异无统计学意义(P>0.05)。观察组及对照组患者术后1个月、3个月围绝经期症状的发生率分别为6.7%vs 3.3%和10.0%vs 6.7%,差异均无统计学意义(P>0.05)。结论绝经前女性因子宫良性疾病行子宫全切除术同时预防性切除双侧输卵管在术后近期内不加重卵巢功能的下降。AMH在评估术后卵巢功能改变上较FSH、LH及E2更为敏感。Objective The risk of ovarian/pelvic serous cancer can be reduced by prophylactic bilateral salpingectomy（ PBS） at the time of hysterectomy. This study was to evaluate the short-term influence of PBS plus hysterectomy on ovarian reserve in premenopausal women. Methods We retrospectively analyzed the clinical data about 60 premenopausal women treated by total laparoscopic hysterectomy（ TLH） for benign indications,30 undergoing PBS at the same time（ the experimental group） while the other 30 with the ovary preserved（ the control group）. We compared the levels of FSH,LH,E2,and anti-Müllerian hormone（ AMH） and the incidence of peri-menopausal symptoms between the two groups of patients before and at 1 and 3 months after operation. Results Statistically significant differences were not observed between the two groups in the such baseline clinical characteristics as age,gravidity,parity,menstrual cycle,comorbidity,diagnosis,comorbidities,and history of abdominal surgery（ P〉0.05）,nor in the AMH level at the baseline（ [1.08±0.08] vs [1.04±0.10] ng/mL） or at 1 month（ [0.86±0.44] vs [0.81±0.48]ng/mL） or 3 months postoperatively（ [0.84±0.94]vs [0.68±0.42]ng/mL）（ F = 0.247,P = 0.746）. However,the mean level of AMH was markedly reduced at 1 and 3 months after operation as compared with the baseline（ P〈0.05）,though with no significant difference between 1 and 3 months（ P〉0. 05）. There were not any statistically significant differences in the levels FSH,LH,and E2 between the two groups before or at 1 and 3 months after surgery（ P 〉0. 05）,nor in the incidence rates of perimenopausal symptoms at 1 month（ 6.7% vs 3.3%,P〈0.05） or 3 months postoperatively（ 10.0% vs 6.7%,P〉0.05）. Conclusion PBS at the time of total hysterectomy in premenopausal women does not affect ovarian reserve in the short term. The level of AMH has a higher sensitivity than those of FSH,LH and E2 in the assessment of postoperative ovarian function.

关 键 词：绝经前女性 全子宫切除术 预防性双侧输卵管切除 抗苗勒管激素 卵巢功能 

分 类 号：R713.4[医药卫生—妇产科学]