肾移植后生育期女性的月经、性生活及生育状况

背景：理论上讲成功的肾移植可以使生育年龄段女性月经正常化，性生活明显改善，肾移植后可以生育，但国内报道不多。目的：通过自制的“生育年龄段女性肾移植后的月经、性生活、生育状况调查表”并配合生活质量评分表、女性性功能指标量表调查不同生育年龄段女性肾移植前后月经、性生活及移植后生育状况，探讨其影响因素。方法：选择2006年1月至 2011年12月在长征医院施行肾移植的生育年龄段患者68例，依据年龄段分为低年组(n=41)和中年组(n=27)，以自制的“生育年龄段女性肾移植后的月经、性生活、生育状况调查表”并配合生活质量评分表、女性性功能指标量表进行门诊和电话随访，观察两组患者移植后3年与血液透析期的月经、性生活、生育状况，并分析其影响因素。结果与结论：54例在肾移植后(3.46±1.23)个月月经改善(低年组38例，中年组16例)，11例改善不明显(低年组3例，中年组8例)，3例较透析前恶化(低年组0例，中年组3例)，其中因月经量过多 2例行诊刮术，1例行宫腔镜止血术；45例在肾移植后(3.43±1.27)个月性生活改善(低年组34例，中年组11例)，11例无明显改善(低年组2例，中年组9例)，12例移植后无性生活史(低年组5例，中年组7例)。7例肾移植后(30.24±7.86)个月受孕(低年组5例，中年组2例)，其中2例生育子女(均为低年组)，5例流产。通过患者肾移植后及移植前进行SF-36量表的调查比较，发现受者在躯体功能、生理职能、躯体疼痛、总体健康、活力领域分值均较移植前明显升高(P < 0.05)，但在情感职能、心理健康及社会功能领域分值与移植前比较，差异无显著性意义(P > 0.05)。肾移植后与肾移植前患者FSFI量表评分比较，发现肾移植后患者性生活质量各指标中，性欲望、性兴奋、阴道润滑、高潮、满意度分值升高，疼痛分值下降，差异均有显著性意义(P < 0.05)。结果可见年龄较大受者月经、性生活状况改善也不明显，在严密监护并认真掌控受孕标准的情况下，女性肾移植受者妊娠是可行、安全的。

Investigation in women of childbearing age after renal transplantation: Menstruation,sexual life and birth condition

BACKGROUND:Theoretically, successful renal transplantation can normalize the menstruation and significantly improve the sexual life of women of childbearing age, and these women can give birth after renal transplantation, but the related domestic reports are rare. OBJECTIVE:To investigate the menstruation, sexual life and birth condition of fertility age women with different ages and to explore the affecting factors through the homemade questionnaire of menstruation, sexual life and birth condition in women of childbearing age after renal transplantation combined with the quality of life scale and female sexual function index scale.METHODS:Sixty-eight women of childbearing age who were treated with renal transplantation in the Changzheng Hospital were selected from January 2006 to December 2011. The patients were divided into young group (n=41) and middle aged group (n=27) on the basis of the age, and then the patients in the two groups received the outpatient and telephone follow-up with a homemade questionnaire of menstruation, sexual life and birth condition questionnaire in women of childbearing age after renal transplantation combined with the quality of life scale and female sexual function index scale. The menstruation, sexual life and birth condition of the patients in two groups were observed at 3 years after transplantation and during the blood dialysis stage.  RESULTS AND CONCLUSION:For the menstruation of patients, 54 cases (38 cases in the young group and 16 cases in the middle aged group) were improved at (3.46±1.23) months after transplantation; 11 cases (three cases in the young group and eight cases in the middle aged group) were improved not obviously; and three cases (0 case in the young group and three cases in the middle aged group) suffered deterioration before blood dialysis, and due to the excessive menstrual volume, two cases received curettage surgery and one case received hysteroscopy hemostatic surgery. For the sexual life of the patients, 45 cases (34 cases in the young group and 11 cases in the middle aged group) were improved at (3.43±1.27) months after transplantation; 11 cases (two cases in the young group and nine cases in the middle aged group) were improved not obviously; 12 cases (five cases in the young group and seven cases in the middle aged group) without sexual life after transplantation. For the birth condition of the patients, there were seven cases of pregnancy (five cases in the young group and two cases in the middle aged group) at (30.24±7.86) months after transplantation, and two cases in the young group had children successfully and the other five cases of abortion. The MOS 36-item short-form health survey before and after transplantation showed that the physical function, bodily pain, general health and vitality field score were significantly increased compared with those before transplantation (P < 0.05), and there were no significant differences in emotional function, mental health and social function score before and after transplantations (P > 0.05). Comparison of the female sexual function index before and after transplantation showed that the scores on sexual desire, sexual excitement, vaginal lubrication, orgasm and satisfaction were increased after transplantation; while the pain score was decreased, and the differences were statistically significant (P < 0.05). The results showed that the menstruation and sexual life of the older recipients were not improved obviously, but the pregnancy of the female recipients was feasible and safe under the strict monitoring and control according to the standard seriously conception.