腹腔镜子宫切除术中子宫动脉处理差异对卵巢功能的影响

目的比较腹腔镜子宫切除术中采用两种不同的子宫动脉处理措施对患者卵巢功能的影响。方法回顾性分析146例行腹腔镜下子宫切除术患者的临床资料,根据子宫动脉处理差异分为两组:研究组70例,行保留子宫动脉上行支的子宫切除术;对照组76例,行传统全子宫切除术。比较两组手术时间、术中出血量、术后病率、围绝经期症状评分以及术后各种并发症发生率的差异;比较两组手术后血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)和孕酮(17-OHP)水平的差异;比较研究组手术前后子宫动脉收缩期血流速度峰值(Va)、舒张期血流速度峰值(Vb)及血流阻力指数(RI)等血流动力学指标的差异。结果研究组手术时间、术中出血量、术后病率均高于对照组,围绝经期症状评分低于对照组(P0.05),但两组术后各种并发症发生率比较均无统计学差异(P0.05)。与对照组比较,研究组术后血清E2水平较高,FSH和LH水平较低(P0.05),但两组血清17-OHP水平无统计学差异(P0.05)。研究组手术前后Va、Vb及RI比较均无统计学差异(P0.05)。结论腹腔镜下行子宫切除术中保留子宫动脉上行支能显著改善卵巢分泌性激素水平,且对卵巢血供无影响。

Effect on Ovarian Function of Laparoscopic Hysterectomy with Preserving Ascending Uterine Artery or not

Objective To compare the clinical effect on ovarian function of laparoscopic hysterectomy （LH） with preserving ascending uterine artery or not. Methods A total of 146 patients carried out laparoscopic hysterectomy（LH） were analyzed retrospectively, inchuding 109 of myoma 31 of dysfunctional uterine bleeding and 6 of hypertrophy of uterus. According to surgical procedure, they were divided into two groups： research group was performed LH with ascending uterine artery reservation in 70 cases, and control group was performed traditional LH in other 76 cases. The indexes of operation time, intra-operative bleeding amount, postoperative morbidity, peri-menopausal symptom score and complications were compared between two groups. The serum gonadal hormone of FSH, LH, E2 and 17-OHP were compared between two groups. The hemodynamic in- dexes of uterine artery systolic velocity peak （Va）, uterine artery diastolic velocity peak （Vb） and blood flow re- sistance index （RI） were compared between pre- and post-operation in research group. Results Compared to control group, the indexes of operation time, intra-operative bleeding amount and post-operative morbidity werehigher （P 〈 0.05）, and peri-menopansal symptom score were lower in research group （P 〈 0.05）. Com- pared to control group, the serum levels of E2 were higher （ P 〈 0.05）, and the serum levels of FSH and LH were lower in research group （P 〈 0.05 ）, but the serum level of 17-OHP had no statistic difference between two groups （ P 〉 0.05 ）. In research group, there was no statistic difference in the hemodynamic indexes of Va, Vb and RI between pre- and post-operation （ P 〉 0. 05 ）. Conclusion The LH with ascending uterine artery reservation can improve the gonadal hormone secretion and ovarian function, and cannot inhibit the ovarian blood supply.