预防性输卵管切除术对卵巢功能的影响及其对盆腔疾病的预防作用

目的：探讨围绝经期女性因子宫良性疾病行开腹全子宫切除术同时预防性切除双侧输卵管对卵巢功能的影响以及对盆腔疾病（卵巢恶性肿瘤、卵巢良性肿瘤和盆腔炎性疾病等）的预防作用。方法：选择因子宫良性疾病行开腹全子宫切除术的患者100例，其中仅行全子宫切除术者50例作为对照组，行全子宫切除术同时行预防性双侧输卵管切除术者50例作为预防组。比较2组患者手术时间、术中出血量、排气时间和住院时间；比较术前及术后6个月、术后1年患者的卵巢基础窦卵泡数目和血清雌二醇（E2）、卵泡刺激素（FSH）及黄体生成素（LH）水平以及围绝经期综合征的发生率，随访患者术后盆腔疾病的发生率。结果：2组患者手术时间、术中出血量、排气时间及住院时间比较差异无统计学意义（P>0.05）；与术前比较，2组患者术后6个月和术后1年卵巢基础窦卵泡数目减少，E2水平降低，FSH和LH水平升高（P<0.01）；但组间卵巢基础窦卵泡数目和E2、FSH及LH水平比较差异无统计学意义（P>0.05）。2组患者术后围绝经期综合征发生率比较差异无统计学意义（P>0.05）。2组患者术后6个月、术后1年卵巢恶性肿瘤和卵巢良性肿瘤发病率比较差异无统计学意义（P>0.05）；对照组患者术后盆腔炎性疾病发病率明显高于预防组（P<0.05）。对照组有2例患者术后确诊为输卵管癌，预防组有2例患者输卵管病理回报见不典型细胞。结论：切除子宫同时行预防性输卵管切除术对患者卵巢功能未见明显影响，且能够有效降低盆腔良、恶性疾病及盆腔炎性疾病的发病率。

Influence of prophylactic bilateral salpingectomy in ovarian function and its preventive effect on pelvic disease

Objective:To study the influence of prophylactic bilateral salpingectomy during hysterectomy in ovarian function of the premenopausal women with benign uterine disease and its preventive effect on the pelvic diseases(malignant /benign pelvic lesions or pelvic inflammatory disease).Methods:A total of 100 patients with benign uterine disease underwent hysterectomy were collected and divided into two groups,including 50 patients underwent simultaneous hysterectomy and prophylactic bilateral salpingectomy (prevention group) and 50 patients underwent only hysterectomy (control group).The operative time,blood loss,evacuation time,and hospitalization time of the patients in two groups were detected;the antral follicle count,levels of serum estradiol(E2),follicle stimulating hormone(FSH) and luteinizing hormone(LH)) and the incidence of perimenopausal symptoms of the patients in two groups before operation and six months,1 year after operation were compared;the incidence of pelvic disease of the patients after operation were compared.Results:The operative time,blood loss,evacuation time,and hospitalization time of the patients between two groups were not significantly different(P>0.05).Compared with before operation,the antral follicle count and the E2 levels of the patients 6 months and 1 year after operation in two groups were decreased,and the FSH and LH levels of the patients were inc reased (P<0.01).There were no significant differences in the levels of FSH,LH,E2 and the antral follicle count of the patients between two groups 6 months and 1 year after operation(P>0.05).The incidence of perimenopausal symptoms of the patients in two groups 6 months and 1 year after operation showed no significant difference(P>0.05).The incidence of ovarian malignant tumor and ovarian benign tumor of the patients in two groups 6 months and 1 year after operation had no significantly differences (P>0.05).The incidence of pelvic inflammatory disease of the patients in control group was higher than that in prevention group(P<0.05).There were 2 patients diagnosed as tubal carcinoma in control group 1 year after operation,and the pathological findings showed the atypical cells in 2 patients in prevention group.Conclusion:Prophylactic bilateral salpingectomy during hysterectomy does not damage the ovarian function and can reduce the incidence of pelvic malignant/ benign tumor and pelvic inflammatory disease.