子宮肌瘤不同術式對卵巢功能影響的研究

胡路琴+汪洪+謝慶煌

【摘要】 目的 探究子宮肌瘤不同手術方式對卵巢功能的影響。方法 選取145例因子宮肌瘤實施手術的患者設為研究組， 按治療方法不同分為腹腔鏡下全子宮切除組（36例）、子宮+雙側輸卵管切除組（33例）、子宮肌瘤剔除組（45例）、子宮三角形切除組（31例）；同時選擇同期在門診體檢的41例子宮肌瘤患者作為對照組。抽取研究組術前及術后3個月靜脈血以及對照組3個月前后靜脈血測定抗苗勒管激素（AMH）、抑制素B（INHB）、卵泡刺激素（FSH）水平并進行比較。結果 研究組術前AMH、FSH、INHB水平與對照組首次比較， 差異無統計學意義（P>0.05）。對照組首次及術后3個月AMH、FSH、INHB水平比較， 差異無統計學意義（P>0.05）。腹腔鏡下全子宮切除組術后3個月AMH水平（2.16±2.49）ng/ml低于術前（3.91±2.25）ng/ml， 且低于對照組（3.76±4.39）ng/ml， 差異有統計學意義（P<0.05）；腹腔鏡下全子宮切除組術后3個月FSH、INHB水平與術前和對照組比較差異均無統計學意義（P>0.05）。子宮+雙側輸卵管切除組術后3個月AMH水平低于術前， 且低于對照組， 差異有統計學意義（P<0.05）；子宮+雙側輸卵管切除組術后3個月FSH水平比術前稍增高， INHB水平比術前稍降低， 但差異均無統計學意義（P>0.05）。子宮+雙側輸卵管切除組術后3個月FSH、INHB水平與對照組比較差異均無統計學意義（P>0.05）。術后3個月， 腹腔鏡下全子宮切除組與子宮+雙側輸卵管切除組AMH水平比較差異無統計學意義（P>0.05）。術后3個月， 子宮肌瘤剔除組和子宮三角形切除組的AMH、FSH、INHB水平分別與術前比較差異無統計學意義（P>0.05）， 與對照組比較差異無統計學意義（P>0.05）。結論 子宮切除術對近期卵巢功能有影響， 子宮肌瘤剔除術和子宮三角形切除術對卵巢近期功能無顯著影響， AMH評估卵巢功能變化比INHB、FSH敏感。

【關鍵詞】 子宮肌瘤；卵巢功能；抗苗勒管激素；抑制素B；卵泡刺激素

DOI：10.14163/j.cnki.11-5547/r.2017.29.009

【Abstract】 Objective To investigate the effect of different uterine leiomyoma operations on ovarian function. Methods A total of 145 patients with uterine fibroids undergoing surgery was selected as research group， and they were divided by different treatment methods into laparoscopic hysterectomy group （36 cases）， uterine + bilateral fallopian tube resection group （33 cases）， myomectomy group （45 cases） and triangular hysterectomy group （31 cases）. Concurrent 41 uterine leiomyoma patients was selected as the control group. The venous blood of the research group before operation and 3 months after operation， and the control group 3 months before and after were collected， for determination of anti-Mullerian hormone （AMH）， inhibin B （INHB） and follicle stimulating hormone （FSH） levels. Results The research group had no statistically significant difference in postoperative AMH， FSH and INHB levels than first time of the control group （P>0.05）. The control group had no statistically significant difference in AMH， FSH and INHB levels of the first time and 3 months after operation （P>0.05）. Laparoscopic hysterectomy group had lower AMH level in 3 months after operation as （2.16±2.49） ng/ml than （3.91±2.25）ng/ml before operation and （3.76±4.39） ng/ml in the control group， and their difference was statistically significant （P<0.05）. Laparoscopic hysterectomy group had no statistically significant difference in FSH and INHB levels at 3 months after operation， comparing with those of before operation and the control group （P>0.05）. Uterine + bilateral fallopian tube resection group had lower AMH levels in 3 months after operation than those of before operation and the control group， and their difference was statistically significant （P<0.05）. Uterine + bilateral fallopian tube resection group had little higher FSH level at 3 months after operation than before operation and little lower INHB level than before operation. But their difference was not statistically significant （P>0.05）. Uterine + bilateral fallopian tube resection group had no statistically significant difference in FSH and INHB levels at 3 months after operation comparing with the control group （P>0.05）. At 3 months after operation， laparoscopic hysterectomy group had no statistically significant difference in AMH level comparing with uterine + bilateral fallopian tube resection group （P>0.05）. At 3 months after operation， myomectomy group and triangular hysterectomy group had no statistically significant difference in AMH， FSH and INHB levels comparing with before operation （P>0.05）， and they had no statistically significant difference comparing with the control group （P>0.05）. Conclusion Hysterectomy has an effect on short-term ovarian function. Myomectomy and triangular hysterectomy have no significant effect on short-term ovarian function， and AMH is more sensitive than INHB and FSH in assessing ovarian function changes.endprint

【Key words】 Uterine leiomyoma； Ovarian function； Anti-mullerian hormone； Inhibin B； Follicule-stimulating hormone

子宮肌瘤是婦科最常見的良性腫瘤， 手術是主要的治療方法。以前認為子宮完成生育功能……