宫腔镜电切除子宫内膜近期对卵功能影响的研究

目的 探讨子宫内膜电切除术后近期对卵巢功能的影响.方法 随机选择2001年1月～2005年10月在青岛大学医学院附属医院因功能失调性子宫出血行子宫内膜电切除术的45岁以下病人(TCRE组)及同期因功能失调性子宫出血行子宫切除而保留双侧卵巢的病人(子宫切除组)各30例,用放射免疫分析法分别检测手术前、术后3个月、术后6个月血清FSH、LH、E2、PRL、P、TT水平,观察月经改变并进行更年期症状评分,配合B超检测卵巢大小、有无卵泡发育,以及测定基础体温,观察手术前后各项内分泌指标的变化以评估卵巢功能是否受到影响.结果 TCRE组双侧卵巢大小及卵泡发育手术前后比较差异无显著性;术后月经改善有效率为93.3%;术后更年期症状评分、血清6项性激素水平与术前比较,差异均无显著性(P＞0.05).子宫切除组术前、术后,患者卵泡发育及更年期症状评分比较差异均有显著性(P＜0.05);术后3个月时测定血清FSH较术前升高,术后6个月时FSH、LH较术前升高,而E2、P水平较术前降低,差异均有显著性(P＜0.05),且与TCRE组比较差异也均具有显著性(P＜0.05).两组基础体温测定术后比较差异有显著性(P＜0.05).结论 在观察期间子宫内膜电切除术对卵巢功能无明显影响,近期不必要行激素替代治疗;而该研究中子宫切除术对卵巢功能有影响.

Study of short term influence of transcervical resection of endometrium (TCRE) on ovarian function

Objective To evaluate the short term influence on ovarian function after transcervical resection of endometrium (TCRE). Methods 30 cases,under 45-year-old,who underwent transcervical resection of endometrium and the other 30 cases who underwent hysterectomy with ovarian reserved during the same period because of abnormal uterine bleeding (the hysterectomy team) were studied by measuring the serum FSH,LH,E2,PRL,P,TT by radio immunoassay preoperation. 3 months and 6 months after the operation,the influnces on ovarian function were evaluated by determining the basal body temperature,measuring the ovary and the follicular development by ultrasonography,scoring the climacteric symptom,and measuring the endocrine index perioperatively. Results In TCRE team,the ovary and the follicular development had no significant difference perioperatively. there were no significant differences between preopration and postoperation in climacteric symptom score and serum sex hormone levels (P >0.05). In the hysterectomy team,comparing with the serum levels preopration,the level of FSH increased at 3 month postoperation,as well as the level of LH at 6 mondth after opreration. While the level of E2 and P decreased,there was significant difference between them (P <0.05). There was significant difference between the two teams (P <0.05). The basal body temperature postoperation in two groups showed significant difference (P <0.05). Conclusion It showed no obviously influence on ovarian function after TRCE during the review time,and it was unnecessary to give hormone replacement therapy during the observing period. Our research shows that hysterectomy has fluence on ovarian function.