子宫切除对卵巢血供和卵巢功能的影响

目的:使用彩色多普勒观察子宫切除前后卵巢血供的变化,在血液动力学水平上了解子宫切除对卵巢功能的影响。方法:对50例子宫切除术患者(子宫全切35例,子宫次全切15例)进行彩色多普勒检查,于术前及术后3、6个月、2年测定子宫动脉卵巢支及卵巢动脉的收缩期最大血流速度(Vmax)、舒张末期最小血流速度(Vmin)、阻力指数(RI)、搏动指数(PI)。同时应用放射免疫方法检测患者手术前后血清雌二醇(E2)、孕酮(P)、卵泡刺激素(FSH)、黄体生成素(LH),根据E2术后2年变化情况,将其作为卵巢功能是否减退的依据。将50例病人分为2组:卵巢功能无减退组(Ⅰ组)16人,卵巢功能减退组(Ⅱ组)34人。结果:对手术前两组子宫动脉卵巢支及卵巢动脉的各血流参数进行比较发现,仅子宫动脉卵巢支的VmaxⅠ组(0·55±0·14)m/s,Ⅱ组(0·45±0·12)m/s]比较有显著性差异(P<0·05),其余各参数比较均无显著性差异(P>0·05);手术后两组的卵巢动脉Vmax、Vmin值下降,RI、PI值升高,两组间各参数比较无显著性差异(P>0·05);每组内手术前后卵巢动脉各参数比较有极其显著性差异(P<0·01)。术前两组间E2Ⅰ组(75·43±37·11)pg/ml,Ⅱ组(197·85±112·46)pg/ml]比较有极其显著性差异(P<0·01)。对子宫全切及子宫次全切不同手术方式患者进行手术前后卵巢动脉的各血流参数比较无显著性差异(P>0·05)。结论:子宫切除可导致术后卵巢动脉Vmax、Vmin值下降,RI、PI值升高;术前子宫动脉卵巢支的Vmax低、E2水平高的患者(Ⅱ组)术后卵巢功能明显下降;术前子宫动脉卵巢支的Vmax高、E2水平低的患者(Ⅰ组)术后2年内卵巢功能不受影响。故术前彩色多普勒检查子宫动脉卵巢支收缩期最大血流速度,并参考血清雌二醇水平对预测子宫切除术后卵巢功能影响程度有重要参考价值。

The study of the influence of hysterectomy on ovary blood flow and ovarian function

Objective:To study the ovary blood flow measured on colour Doppler ultrasound before and after hysterectomy, so as to explore the influence of hysterectomy on ovarian function.Methods:Total 50 cases (35 cases of hysterectomy, 15cases of subtotal hysterectomy) accepted color Doppler examine, the blood flow of ovary branch of uterine artery were observed before hysterectomy, and that of ovary artery were did before and 3, 6 months, 2 years after hysterectomy. The maximal systolic flow velocity (Vmax), end-diastolic minimal flow velocity (Vmin), resistance index (RI), pulsed index (PI) were measured. Radioimmunoassay was used to detect the levels of serum E2, P, FSH and LH before and 3, 6 months, 2 years after operations. 50 cases were divided into 2 groups according to E2 levels change 2 years after operations. 16 cases without E2 descending (without ovarian function decreasing) were assigned into group Ⅰ, and 34 cases with E2 descending ( with ovarian function decreasing) were assigned into group Ⅱ.Results:The Vmax of ovary branch of uterine artery in group Ⅰ (0.55±0.14 m/s) was higher than that in the group Ⅱ (0.45±0.12 m/s) before operations (P<0.05), the Vmin, RI, PI between the two groups had no statistic difference (P>0.05).The Vmax, Vmin of ovary artery were significantly descended, and the PI, RI were significantly ascended after operations in both groups, compared with that before operation (P<0.01). The levels of E2 in group Ⅰ (75.43±37.11 pg/ml) was significantly lower than that in the group Ⅱ (197.85±112.46 pg/ml) before operations (P<0.01).There were no statistic difference between hysterectomy and subtotal hysterectomy before and after operation.Conclusion:The hysterectomy results in the decrease of Vmax,Vmin of the ovary artery and increase of the PI, RI. The ovarian function dosen't decrease in those patients with higher Vmax and lower E2. The Vmax of the blood flow of ovary branch of uterine artery hemodynamics monitored by the color Doppler and the serum level of E2 are useful in the prediction on ovary function after hysterectomy.