子宫肌瘤不同术式对女性内分泌影响的研究
摘要
随着生活水平的日益提高,妇科手术对女性内分泌的影响越来越受到人们的关注,子宫肌瘤的手术方式一直是妇科医师争论的焦点。本文通过研究子宫肌瘤不同术式对女性内分泌的影响,探讨子宫、卵巢最合理的术式为维持女性内环境的稳定和术后的激素替代治疗提供参考。按子宫肌瘤病人不同术式分为4 组共80 例。分别于术前、术后不同时期测定体内激素水平。行子宫肌瘤剥出术的患者20 例:术后激素水平无变化,说明对女性内分泌无影响;行保留双侧附件的子宫切除术的患者20 例:术后1 周、8 周各激素水平无变化。术后24 周测定血中FSH、LH 值略升高,但与术前比较无显著性差异(P>0.05),E2值降低与术前比较有显著性差异(P<0.05),说明此种术式远期使卵巢功能有所减退甚至早衰;行保留单侧附件的子宫切除术的患者20 例:术后1 周E2值降低与术前比较有显著性差异(P<0.05),其它激素水平无变化。术后8 周、术后24 周测定血中FSH、LH 值升高,E2值降低与术前比较均有高度显著性差异(P<0.01)。可见保留一侧卵巢,不能很好地维持女性雌激素水平;行切除双侧附件的全子宫切除术的患者20 例:术后1 周E2值降低与术前比较有高度显著性差异(P<0.01),其它激素水平无变化,术
Objective: To study the influence on the hormone level ofwomen with myoma of uterus after different operation of uterusand ovary, and to explore the most reasonable operative typesprovide basis for post-operation hormone replacement therapy.
Methods: 80 female patients with myoma of uteruswere averagely divided into 4 groups according to the type ofoperation: groupⅠ: 20 patients with hysteromyomectomy; groupⅡ:20 patients with simple hysterectomy; groupⅢ:20 patients withhysterectomy plus uni-lateral adnexctomy; groupⅣ:20 patientswith hysterectomy plus bilateral adnexectomy. The level ofFSH 、LH、E2 、P、and T were detected respectively beforeoperation and in a week、8 weeks and 24 weeks after operation .Adopting the analyze system which named BECKMANCOUITER ACCESS ? made by USA. and BECKMAN reagent,measured the FSH 、LH、E2、P and T in serum by the method ofchemistry luminesce.
Results: In groupⅠ, the hormone level showed no statisticaldifferences at a week、8 weeks and 24 weeks after operationcompared with pre-operation (P>0.05).In group Ⅱ, the hormonelevels of FSH、LH、E2 、P and T showed no statisticaldifferences at a week and 8 weeks after operation compared withpre-operation (P>0.05);the levels of FSH and LH increased butshowed no statistical differences at 24 weeks after operationcompared with pre-operation (P>0.05); and the level of E2declined and there were statistical differences at 24 weeks afteroperation compared with pre-operation (P<0.01); The levels of Pand T showed no statistical differences compared withpre-operation (P>0.05). In group Ⅲ, the hormone levels of FSH、LH 、P and T showed no statistical differences at a week andafter operation compared with pre-operation (P>0.05); the level ofE2 declined and there were statistical differences at a week afteroperation compared with pre-operation (P<0.05); the levels ofFSH and LH increased and the level of E2 declined and there werestatistical differences at 8 weeks and 24 weeks after operationcompared with pre-operation (P<0.01); The levels of P and T
showed no statistical differences compared with pre-operation(P>0.05). In group Ⅳ: the hormone levels of FSH、LH 、P and Tshowed no statistical differences at a week and after operationcompared with pre-operation (P>0.05);the level of E2 declined andthere were statistical differences at a week after operationcompared with pre-operation (P<0.01); the levels of FSH and LHincreased and the level of E2 declined and there were statisticaldifferences at 8 weeks and 24 weeks after operation comparedwith pre-operation (P<0.01); The levels of P and T declined butshowed no statistical differences at 8 weeks and 24 weeks afteroperation compared with pre-operation (P>0.05). Conclusion: In hysteromyomectomy, the uterine artery wasremained and the blood supply of ovaries was adequate. Theovaries had normal functions. So patients of hysteromyomectoryhad no influence on hormones. In hysterectomy with both-sideovary remaining, because of the damage of the integration inanatomy between ovary and uterus,the blood supply of ovarieswas reduced, and the function of ovary were influenced. Therefore,the levels of hormones were reduced. In hysterectomy with
Objective: To study the influence on the hormone level ofwomen with myoma of uterus after different operation of uterusand ovary, and to explore the most reasonable operative typesprovide basis for post-operation hormone replacement therapy.
Methods: 80 female patients with myoma of uteruswere averagely divided into 4 groups according to the type ofoperation: groupⅠ: 20 patients with hysteromyomectomy; groupⅡ:20 patients with simple hysterectomy; groupⅢ:20 patients withhysterectomy plus uni-lateral adnexctomy; groupⅣ:20 patientswith hysterectomy plus bilateral adnexectomy. The level ofFSH 、LH、E2 、P、and T were detected respectively beforeoperation and in a week、8 weeks and 24 weeks after operation .Adopting the analyze system which named BECKMANCOUITER ACCESS ? made by USA. and BECKMAN reagent,measured the FSH 、LH、E2、P and T in serum by the method ofchemistry luminesce.
Results: In groupⅠ, the hormone level showed no statisticaldifferences at a week、8 weeks and 24 weeks after operationcompared with pre-operation (P>0.05).In group Ⅱ, the hormonelevels of FSH、LH、E2 、P and T showed no statisticaldifferences at a week and 8 weeks after operation compared withpre-operation (P>0.05);the levels of FSH and LH increased butshowed no statistical differences at 24 weeks after operationcompared with pre-operation (P>0.05); and the level of E2declined and there were statistical differences at 24 weeks afteroperation compared with pre-operation (P<0.01); The levels of Pand T showed no statistical differences compared withpre-operation (P>0.05). In group Ⅲ, the hormone levels of FSH、LH 、P and T showed no statistical differences at a week andafter operation compared with pre-operation (P>0.05); the level ofE2 declined and there were statistical differences at a week afteroperation compared with pre-operation (P<0.05); the levels ofFSH and LH increased and the level of E2 declined and there werestatistical differences at 8 weeks and 24 weeks after operationcompared with pre-operation (P<0.01); The levels of P and T
showed no statistical differences compared with pre-operation(P>0.05). In group Ⅳ: the hormone levels of FSH、LH 、P and Tshowed no statistical differences at a week and after operationcompared with pre-operation (P>0.05);the level of E2 declined andthere were statistical differences at a week after operationcompared with pre-operation (P<0.01); the levels of FSH and LHincreased and the level of E2 declined and there were statisticaldifferences at 8 weeks and 24 weeks after operation comparedwith pre-operation (P<0.01); The levels of P and T declined butshowed no statistical differences at 8 weeks and 24 weeks afteroperation compared with pre-operation (P>0.05). Conclusion: In hysteromyomectomy, the uterine artery wasremained and the blood supply of ovaries was adequate. Theovaries had normal functions. So patients of hysteromyomectoryhad no influence on hormones. In hysterectomy with both-sideovary remaining, because of the damage of the integration inanatomy between ovary and uterus,the blood supply of ovarieswas reduced, and the function of ovary were influenced. Therefore,the levels of hormones were reduced. In hysterectomy with
引文
1 Centerwall B S.Premenopausal hysterectomy and cardiovascular disease.Am J Obstet Gynecol.1981,139:58
2 乐杰主编.妇产科学,第五版.北京:人民卫生出版社,2000, 323
3 Dogle IL,Bareloy DL,Duncan GW,et al.Human Iuteal function following hysterectomy as assessed by plasma progestin.Am J Obstet Gynecol,1971,110;92
4 Stone Sc, Dickey RP, Mickal A. The acute effect of hysterectomy on ovarian function. Am J obstet Gynecol;1975,121:193-197
5 Souza A Z ,fonseca A M, Izzo V M ,et .Ovarian histology and function fter total abdominal hysterectomy(J). Obster Gynecol ,1986 , 68:847-849
6 Banrofy-Livingston G .Ovarian survival following hysterectomy.Obstet Gynecol Br EMP,1954,61:628-638
7 梁志清.子宫切除术对卵巢血供及其功能的影响.国外医学妇 产科分册1999,26(2):119-120
8 Randall CL , Birtch PH , Herkins J L. Ovarian function after the menopause .Am J Obstet Gynecol,1957, 74:719-732
9 Siddle N ,Sarrel P ,Whitefead M .The effect of hysterectomy on the age at ovarion failure identification of a subgroup of women with premature loss of ovarian function and Literature review Fertil Steril 1987,47:94-100
10 Riedel HH,Lehmann-Willenbrock E, Semm K. Ovarian failure phenomena after hysterectomy. J ReprodMed, 1986, 31: 597-600
11 Nilas L, Loft A. Ovarian function after premenopausal hysterectomy (see comments). Ugeskr Laeger,1993,155:3818
12 Hartmann BW,Kirchengast S,Albrecht A,et al.Hysteretomy increase the symptomatology of postmenopausal syndrome. Gynecol Endocrinol,1995,9:247-251
13 Habelt K,Brosche T, Riedel HH.Symptoms of ovarian failure after hysterectomy in premenopausal women: A retrospective study based on postoperative perception of 245 women.Zentralbl Gynakol, 1996,118:206
14 Janson PO, Janson I.The acute effect of hysterectomy on ovarian blood flow.Am J Obstet Gynecol, 1977,127:349-352
15 Biro JC, Eneroth P. Inhibitory effect of the uterus on plasma and pituitary FSH in rats. J Endocrinol, 1990,124(2):183-189
16 Sessums JV, Murphy DP.The influence of endometrium upon the rabbit ovary after hysterectomy. Surg Gynecol Obstet,1933,56:600
17 Carranza-Lira S, Murillo-Uribe A, Martinez Trejo N, et al.Changes in symptomatology, hormones,lipids, and bone density after hysterectomy. Int J Fertil Womens Med,1997,42:4
18 左常婷.子宫肌瘤手术治疗进展.实用妇产科杂志,2000,16 (4):183-185
19 吴雪清.子宫切除对育龄妇女血糖、血脂及卵巢功能的影响.现代妇产科进展杂志,1999,8(2):150-152
20 田杰,赵曼曼,温锦英.不同术式子宫切除术对患者内分泌功能及骨代谢的影响.中国实用妇科与产科杂志,2003,19 (8):497-498
21 曹美良.不同术式切除子宫、卵巢对内分泌及更年期症状的影响.实用妇产科杂志,2000,16(2):79-80
22 龙丽霞.子宫、卵巢不同术式对中青年妇女内分泌的影响. 现代妇产科进展,2003,12(2):117-119
23 吴望灵.子宫肌瘤手术卵巢去留对妇女生活质量的影响.实用妇产科杂志,1999,15(6):312-313
24 Siddle N , Sarrel P, Whitehead H .The effect of hysterectomy on the age at ovarian failure identifications of a subgroup of review .Fertil Steril , 1987;47(2):94
25 Oldenhave A, Jasjmann J B, Everaerde TH , et al. Hysterctomized women with ovaria conservation report more severe climacteric complaints that do normal climacteric women of similar age. Am Obstet Gynecol 1993; 168:765
26 程桂丽,刘世兰.宫腔电切镜治疗粘膜下子宫肌瘤及功血等120 例分析[J].实用妇科与产科杂志,2003,19(5):301 -302
27 朱关珍,张惜阴潘明明等.子宫肌瘤手术时切除卵巢与保留卵巢体内性激素水平的变化.上海医学1984;7:453。
28 李家福,刘永玉.子宫切除对卵巢功能的影响[J] .中国实用妇科与产科杂志1999,15(12):711
29 王明乾,正确应用子宫切除术提高手术效果.实用妇科与产科杂志,1991,7(2):58
30 洪颖,胡志沁.一侧卵巢切除术对性激素水平及骨代谢的影响[J].中华妇产科杂志,1997,32:46-47
31 张琴.卵巢切除后内分泌和生化学变化[J].中华妇产科杂志,1987,22:281-284
32 刘隶临.良性子宫手术处理问题座谈会总结[J].中华妇产科杂志,1984,19:65
33李联昆.残余卵巢癌及其预后[J].中国实用妇科与产科杂志,1999,12:716-717
34 Beard M. The epidemiology of ovarian cancer: a population-based study in Olmsted County, Minnesota, 1935-1991.Am Epidemiol, 2000, 38: 683-726
35 郑英,崔金全,李培育.残余卵巢功能脱失及激素治疗[J]. 中国实用妇科与产科杂志,1999,12:718-719
36 屠蕊沁,王美珍.卵巢切除术后雌激素变化对骨密度的影响[J].上海医科大学学报,1998,25:389-391
37 Dalay D C ,ct al Prolactin production from prolifcrative phase lciomyoma ,Am J Obs Gyn.1984;148:1059
38 蔡培茜.绝经前子宫切除对妇女健康的影响.实用妇科与产科杂志。1991。7:79
39 宋琳如,李惠玲,柯佩琪.妇科良性疾病剖腹时子宫及卵巢去留的探讨. 新医学,1994;25:65
40 孙宝治,蔡裴茜.子宫内分泌功能及作用.中国实用妇科与产科杂志,1991;15(5):277
41 石一复.妇产科和外科医生在手术中应遵循的原则.现代手术学杂志,1996;1(2):77
42 蔡桂茹.关于预防性卵巢切除的问题.国外医学计划生育妇 产科学分册,1975;(2):105
43 蒋味根.妇科良性肿瘤手术时卵巢去留问题.见王德智,石一复主编,中国妇产科专家经验文集,沈阳:沈阳出版社994; 479
44 焦书竹,金嘉瑜,牛秀敏等.子宫肌瘤的子宫切除术式与卵巢去留的探讨.中华医学杂志,984;19(2);71
45 杨品.卵巢残留综合症.妇产科专题讲座,广州;广东科技出版社,1988;173
46 Arulkumaran S.Prophylactic Oophorectomy:A Continuing Controversy.Obstetrical and Gynecological Survey, 1998,53(8):493-499
47 Leeper K, Garcia R Swisher E, et al. Pathologic findings in prophylactic oophorectomy specimens in high-risk women. Gynecol Oncol,2002,87:52-56
48 Parazzini F,Negri E, Vecchia C et al. Hysterectomy, oophorectomy, and subsequent ovarian cancer risk. Obstet Gynecol, 1993,81 (3):363-366
49 曹泽毅.中华妇产科学(下).北京:人民卫生出版社1999, 1819-1825
2 乐杰主编.妇产科学,第五版.北京:人民卫生出版社,2000, 323
3 Dogle IL,Bareloy DL,Duncan GW,et al.Human Iuteal function following hysterectomy as assessed by plasma progestin.Am J Obstet Gynecol,1971,110;92
4 Stone Sc, Dickey RP, Mickal A. The acute effect of hysterectomy on ovarian function. Am J obstet Gynecol;1975,121:193-197
5 Souza A Z ,fonseca A M, Izzo V M ,et .Ovarian histology and function fter total abdominal hysterectomy(J). Obster Gynecol ,1986 , 68:847-849
6 Banrofy-Livingston G .Ovarian survival following hysterectomy.Obstet Gynecol Br EMP,1954,61:628-638
7 梁志清.子宫切除术对卵巢血供及其功能的影响.国外医学妇 产科分册1999,26(2):119-120
8 Randall CL , Birtch PH , Herkins J L. Ovarian function after the menopause .Am J Obstet Gynecol,1957, 74:719-732
9 Siddle N ,Sarrel P ,Whitefead M .The effect of hysterectomy on the age at ovarion failure identification of a subgroup of women with premature loss of ovarian function and Literature review Fertil Steril 1987,47:94-100
10 Riedel HH,Lehmann-Willenbrock E, Semm K. Ovarian failure phenomena after hysterectomy. J ReprodMed, 1986, 31: 597-600
11 Nilas L, Loft A. Ovarian function after premenopausal hysterectomy (see comments). Ugeskr Laeger,1993,155:3818
12 Hartmann BW,Kirchengast S,Albrecht A,et al.Hysteretomy increase the symptomatology of postmenopausal syndrome. Gynecol Endocrinol,1995,9:247-251
13 Habelt K,Brosche T, Riedel HH.Symptoms of ovarian failure after hysterectomy in premenopausal women: A retrospective study based on postoperative perception of 245 women.Zentralbl Gynakol, 1996,118:206
14 Janson PO, Janson I.The acute effect of hysterectomy on ovarian blood flow.Am J Obstet Gynecol, 1977,127:349-352
15 Biro JC, Eneroth P. Inhibitory effect of the uterus on plasma and pituitary FSH in rats. J Endocrinol, 1990,124(2):183-189
16 Sessums JV, Murphy DP.The influence of endometrium upon the rabbit ovary after hysterectomy. Surg Gynecol Obstet,1933,56:600
17 Carranza-Lira S, Murillo-Uribe A, Martinez Trejo N, et al.Changes in symptomatology, hormones,lipids, and bone density after hysterectomy. Int J Fertil Womens Med,1997,42:4
18 左常婷.子宫肌瘤手术治疗进展.实用妇产科杂志,2000,16 (4):183-185
19 吴雪清.子宫切除对育龄妇女血糖、血脂及卵巢功能的影响.现代妇产科进展杂志,1999,8(2):150-152
20 田杰,赵曼曼,温锦英.不同术式子宫切除术对患者内分泌功能及骨代谢的影响.中国实用妇科与产科杂志,2003,19 (8):497-498
21 曹美良.不同术式切除子宫、卵巢对内分泌及更年期症状的影响.实用妇产科杂志,2000,16(2):79-80
22 龙丽霞.子宫、卵巢不同术式对中青年妇女内分泌的影响. 现代妇产科进展,2003,12(2):117-119
23 吴望灵.子宫肌瘤手术卵巢去留对妇女生活质量的影响.实用妇产科杂志,1999,15(6):312-313
24 Siddle N , Sarrel P, Whitehead H .The effect of hysterectomy on the age at ovarian failure identifications of a subgroup of review .Fertil Steril , 1987;47(2):94
25 Oldenhave A, Jasjmann J B, Everaerde TH , et al. Hysterctomized women with ovaria conservation report more severe climacteric complaints that do normal climacteric women of similar age. Am Obstet Gynecol 1993; 168:765
26 程桂丽,刘世兰.宫腔电切镜治疗粘膜下子宫肌瘤及功血等120 例分析[J].实用妇科与产科杂志,2003,19(5):301 -302
27 朱关珍,张惜阴潘明明等.子宫肌瘤手术时切除卵巢与保留卵巢体内性激素水平的变化.上海医学1984;7:453。
28 李家福,刘永玉.子宫切除对卵巢功能的影响[J] .中国实用妇科与产科杂志1999,15(12):711
29 王明乾,正确应用子宫切除术提高手术效果.实用妇科与产科杂志,1991,7(2):58
30 洪颖,胡志沁.一侧卵巢切除术对性激素水平及骨代谢的影响[J].中华妇产科杂志,1997,32:46-47
31 张琴.卵巢切除后内分泌和生化学变化[J].中华妇产科杂志,1987,22:281-284
32 刘隶临.良性子宫手术处理问题座谈会总结[J].中华妇产科杂志,1984,19:65
33李联昆.残余卵巢癌及其预后[J].中国实用妇科与产科杂志,1999,12:716-717
34 Beard M. The epidemiology of ovarian cancer: a population-based study in Olmsted County, Minnesota, 1935-1991.Am Epidemiol, 2000, 38: 683-726
35 郑英,崔金全,李培育.残余卵巢功能脱失及激素治疗[J]. 中国实用妇科与产科杂志,1999,12:718-719
36 屠蕊沁,王美珍.卵巢切除术后雌激素变化对骨密度的影响[J].上海医科大学学报,1998,25:389-391
37 Dalay D C ,ct al Prolactin production from prolifcrative phase lciomyoma ,Am J Obs Gyn.1984;148:1059
38 蔡培茜.绝经前子宫切除对妇女健康的影响.实用妇科与产科杂志。1991。7:79
39 宋琳如,李惠玲,柯佩琪.妇科良性疾病剖腹时子宫及卵巢去留的探讨. 新医学,1994;25:65
40 孙宝治,蔡裴茜.子宫内分泌功能及作用.中国实用妇科与产科杂志,1991;15(5):277
41 石一复.妇产科和外科医生在手术中应遵循的原则.现代手术学杂志,1996;1(2):77
42 蔡桂茹.关于预防性卵巢切除的问题.国外医学计划生育妇 产科学分册,1975;(2):105
43 蒋味根.妇科良性肿瘤手术时卵巢去留问题.见王德智,石一复主编,中国妇产科专家经验文集,沈阳:沈阳出版社994; 479
44 焦书竹,金嘉瑜,牛秀敏等.子宫肌瘤的子宫切除术式与卵巢去留的探讨.中华医学杂志,984;19(2);71
45 杨品.卵巢残留综合症.妇产科专题讲座,广州;广东科技出版社,1988;173
46 Arulkumaran S.Prophylactic Oophorectomy:A Continuing Controversy.Obstetrical and Gynecological Survey, 1998,53(8):493-499
47 Leeper K, Garcia R Swisher E, et al. Pathologic findings in prophylactic oophorectomy specimens in high-risk women. Gynecol Oncol,2002,87:52-56
48 Parazzini F,Negri E, Vecchia C et al. Hysterectomy, oophorectomy, and subsequent ovarian cancer risk. Obstet Gynecol, 1993,81 (3):363-366
49 曹泽毅.中华妇产科学(下).北京:人民卫生出版社1999, 1819-1825