全子宫切除联合双侧输卵管切除术对患者血清AMH及卵巢功能的影响

目的：探讨全子宫切除术联合双侧输卵管切除术对患者卵巢功能及血清抗苗勒管激素(AMH)的影响。方法收集2013年1月至2015年6月我院妇科拟行腹腔镜全子宫切除术治疗的子宫良性疾病患者188例，其中，72例同时行双侧输卵管切除术者为观察组，116例保留双侧输卵管者为对照组。比较两组患者手术前后的血清AMH水平及卵巢功能的差异。结果观察组患者术中出血量为(56.23±13.59) mL，手术时间为(109.12±15.78) min，术后肛门排气时间为(19.21±4.31) h，术后住院时间为(4.53±1.12) d，对照组依次为(55.34±12.68) mL、(107.87±16.02) min、(19.45±4.62) h、(4.67±1.35) d，组间比较差异均无统计学意义(P>0.05)；术后1个月、3个月，两组患者的卵泡生成激素(FSH)、黄体生成激素(LH)升高，雌二醇(E2)、AMH降低(P<0.05)，但组间术后比较差异均无统计学意义(P>0.05)；术后3个月观察组与对照组的Kupperman评分分别为(5.29±1.43)分、(5.15±1.29)分，两组均较术前显著升高(P<0.05)，但组间比较差异均无统计学意义(P>0.05)；观察组7例(9.72%)确诊为围绝经期综合征(MPS)，与对照组12例(10.34%)比较差异无统计学意义(P>0.05)。观察组盆腔包裹性积液发生率为1.39%，显著低于对照组的14.66%，差异有统计学意义(P<0.05)。结论全子宫切除术可导致卵巢功能及血清AMH降低，但术中联合双侧输卵管切除术并不加重这种影响，且可降低盆腔包块发生率，建议预防性切除。

Effect of total hysterectomy and bilateral fallopian tube resection on serum anti-Mullerian hormone and ovarian function in patients

Objective To investigate the effect of total hysterectomy combined with bilateral fallopian tube re-section on ovarian function and serum anti-Mullerian hormone (AMH). Methods A total of 188 cases of patients with benign uterine diseases, who admitted to Department of Gynecology of our hospital and underwent laparoscopic hyster-ectomy resection from January 2013 to June 2015, were collected as the research objects. Among them, 72 cases under-went simultaneously bilateral fallopian tube resection were taken as the observation group, and 116 cases of preservation of bilateral fallopian canal were taken as the control group. The differences of serum AMH level and ovarian function be-tween the two groups before and after operation were compared. Results There were no significant differences between the observation group of (56.23±13.59) mL, (109.12±1.578) min, (19.21±4.31) h, (4.53±1.12) d and the control group of (55.34±12.68) mL, (107.87±16.02) min, (19.45±4.62) h, (4.67±1.35) d in the amount of bleeding, operation time, anal ex-haust time, postoperative hospitalization time (P>0.05). After 1 and 3 months of operation, there was a significant in-crease trend for follicle-stimulating hormone (FSH) and luteinising hormone (LH), and a significant decrease trend for estradiol (E2) and AMH in the two groups (P<0.05), but there was no significant difference between the two groups in these index (P>0.05). After 3 months of operation, there was a significant increase on Kupperman score in the observa-tion group of (5.29±1.43) points and the control group of (5.15±1.29) points, P<0.05, but there was no significant differ-ence between the two groups (P>0.05). There was no significant difference between the observation group (n=7, 9.72%) and the control group (n=12, 10.34%) in diagnosed perimenopausal syndrome (MPS), P>0.05. The incidence rate of pel-vic encapsulated effusion in the observation group (1.39%) was significantly lower than that of the control group (14.66%), P<0.05. Conclusion Total hysterectomy can lead to ovarian function and serum AMH decrease, and bilater-al tubal resection does not aggravate this effect and can reduce the incidence rate of pelvic mass, which is recommended for preventive removal.