不同子宫全切术式对卵巢功能影响
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摘要
目的:探讨不同术式子宫全切术手术对卵巢功能影响。方法:选取2016年3月—2018年3月在本院行子宫全切术60例,按照手术方法不同分为传统手术组和腹腔镜组,每组30例。腹腔镜组全身麻醉下行腹腔镜子宫全切除术,传统手术组全身麻醉下行传统开腹子宫切除手术。分别观察记录两组患者的术中出血量、手术时间、排气时间、住院时间。检测两组促卵泡生成激素(FSH)、雌二醇(E_2)、促黄体生成激素(LH)、抗中肾旁管激素(AMH)及基础卵泡数等。术后随访半年,比较两组并发症。结果:腹腔镜组术中出血量、手术时间、排气时间、住院时间均低于传统手术组(P<0.05),术后两组E_2和AMH水平均降低,FSH和LH水平升高,传统手术组基础卵泡数目下降(P<0.05),腹腔镜组并发症发生率低于传统手术组(P<0.05)。结论:AMH在两种子宫全切术手术后血清水平均降低,但腹腔镜组的变化幅度较小,腹腔镜子宫全切术对卵巢功能的影响较小,适宜临床应用。
Objective: To investigate the change of serum level of anti mullerian hormone(AMH) of women before and after hysterectomy, and to study its clinical value for evaluating ovarian function. Methods: 60 women who experienced hysterectomy from May 2015 to May 2016 were selected as the study objects, and they were divided into control group and study group according to different surgical methods(30 cases in each group). The women in study group underwent laparoscopic hysterectomy, and women in control group underwent conventional open hysterectomy. The blood loss, operation time, exhaust time and hospitalization time of women in both groups were recorded. The ovarian reserve parameters such as levels of FSH, E_2, LH and AMH, and basal follicle number of all women were detected. All postoperative women were followed up for half a year and the complications of women were compared between the two groups. Results: The intraoperative bleeding volume, operation time, exhaust time, and hospitalization time of women in study group were significant lower than those of women in control group(P<0.05).The levels of serum E_2 and AMH of all women decreased after operation, and the levels of serum FSH and LH of all women increased. The number of basal follicles of women in control group decreased more than that of women in study group(P<0.05). The incidence of complications of women in study group was significant lower than that of women in control group(P<0.05). Conclusion: The serum AMH level of women decreases after hysterectomy, but the change range of women experienced laparoscopic hysterectomy group is less than that of women with conventional open hysterectomy, so laparoscopic hysterectomy has less influence on ovarian function, and it should be popularized in clinic.
Objective: To investigate the change of serum level of anti mullerian hormone(AMH) of women before and after hysterectomy, and to study its clinical value for evaluating ovarian function. Methods: 60 women who experienced hysterectomy from May 2015 to May 2016 were selected as the study objects, and they were divided into control group and study group according to different surgical methods(30 cases in each group). The women in study group underwent laparoscopic hysterectomy, and women in control group underwent conventional open hysterectomy. The blood loss, operation time, exhaust time and hospitalization time of women in both groups were recorded. The ovarian reserve parameters such as levels of FSH, E_2, LH and AMH, and basal follicle number of all women were detected. All postoperative women were followed up for half a year and the complications of women were compared between the two groups. Results: The intraoperative bleeding volume, operation time, exhaust time, and hospitalization time of women in study group were significant lower than those of women in control group(P<0.05).The levels of serum E_2 and AMH of all women decreased after operation, and the levels of serum FSH and LH of all women increased. The number of basal follicles of women in control group decreased more than that of women in study group(P<0.05). The incidence of complications of women in study group was significant lower than that of women in control group(P<0.05). Conclusion: The serum AMH level of women decreases after hysterectomy, but the change range of women experienced laparoscopic hysterectomy group is less than that of women with conventional open hysterectomy, so laparoscopic hysterectomy has less influence on ovarian function, and it should be popularized in clinic.
引文
[1] 涂皎, 肖雁冰, 曹丽,等. 全子宫与次全子宫切除术治疗子宫肌瘤对女性卵巢功能的影响[J]. 实用妇产科杂志, 2016, 32(4):278-281.
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[3] 赵明红, 赵艳, 常春艳,等. 全子宫切除术同时切除双侧输卵管对卵巢功能的影响[J]. 检验医学与临床, 2017, 14(10):1504-1505.
[4] de Kat A C, Broekmans F J, Laven J S, et al. Anti-Mullerian Hormone as a marker of ovarian reserve in relation to cardio-metabolic health: a narrative review.[J]. Maturitas, 2015, 80(3):251-257.
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[6] 李敏香, 黄李芸, 陈丽娟. 腹腔镜全子宫切除术护理优势的原因分析[J]. 重庆医学, 2015,44(11):1577-1578.
[7] 丁森君, 路俊兰, 张薏女. 子宫肌瘤子宫全切术后患者卵巢内分泌功能的变化与研究[J]. 中国性科学, 2015, 24(1):26-28.
[8] 王红. 腹腔镜全子宫切除术和腹腔镜次全子宫切除术对患者卵巢功能及其性功能的影响[J]. 中国计划生育和妇产科, 2016, 8(5):58-61.
[9] Dupont J, Scaramuzzi R J. Insulin signalling and glucose transport in the ovary and ovarian function during the ovarian cycle[J]. Biochemical Journal, 2016, 473(11):1483-1501.
[10] Aungier S P M, Roche J F, Duffy P, et al. The relationship between activity clusters detected by an automatic activity monitor and endocrine changes during the periestrous period in lactating dairy cows[J]. Journal of Dairy Science, 2015, 98(3):1666-1684.
[11] 黄佳语, 高颖. AMH与卵巢储备功能及体外胚胎发育潜能的关系[J]. 生殖医学杂志, 2017, 26(1):82-86.
[12] 姚国荣. 腹腔镜下全子宫切除术术后并发症发生的相关因素分析[J]. 浙江医学, 2015, 37(5):386-388.
[13] 殷新明, 刘颂平, 温坚. 腹腔镜下全子宫切除226例并发症分析[J]. 中国妇幼保健, 2015, 30(7):1135-1138.
[2] 任小霞, 汤晓秋, 王艳君. 不同手术方式子宫切除术对患者生殖系统及性功能的影响[J]. 陕西医学杂志, 2016, 45(10):1294-1296.
[3] 赵明红, 赵艳, 常春艳,等. 全子宫切除术同时切除双侧输卵管对卵巢功能的影响[J]. 检验医学与临床, 2017, 14(10):1504-1505.
[4] de Kat A C, Broekmans F J, Laven J S, et al. Anti-Mullerian Hormone as a marker of ovarian reserve in relation to cardio-metabolic health: a narrative review.[J]. Maturitas, 2015, 80(3):251-257.
[5] 倪骎骎. 腹腔镜下全子宫切除术效果及对患者生活质量影响分析[J]. 中国计划生育学杂志, 2015, 23(3):201-202.
[6] 李敏香, 黄李芸, 陈丽娟. 腹腔镜全子宫切除术护理优势的原因分析[J]. 重庆医学, 2015,44(11):1577-1578.
[7] 丁森君, 路俊兰, 张薏女. 子宫肌瘤子宫全切术后患者卵巢内分泌功能的变化与研究[J]. 中国性科学, 2015, 24(1):26-28.
[8] 王红. 腹腔镜全子宫切除术和腹腔镜次全子宫切除术对患者卵巢功能及其性功能的影响[J]. 中国计划生育和妇产科, 2016, 8(5):58-61.
[9] Dupont J, Scaramuzzi R J. Insulin signalling and glucose transport in the ovary and ovarian function during the ovarian cycle[J]. Biochemical Journal, 2016, 473(11):1483-1501.
[10] Aungier S P M, Roche J F, Duffy P, et al. The relationship between activity clusters detected by an automatic activity monitor and endocrine changes during the periestrous period in lactating dairy cows[J]. Journal of Dairy Science, 2015, 98(3):1666-1684.
[11] 黄佳语, 高颖. AMH与卵巢储备功能及体外胚胎发育潜能的关系[J]. 生殖医学杂志, 2017, 26(1):82-86.
[12] 姚国荣. 腹腔镜下全子宫切除术术后并发症发生的相关因素分析[J]. 浙江医学, 2015, 37(5):386-388.
[13] 殷新明, 刘颂平, 温坚. 腹腔镜下全子宫切除226例并发症分析[J]. 中国妇幼保健, 2015, 30(7):1135-1138.