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绝经前期腹腔镜全子宫切除同双侧输卵管与全子宫切除患者AMH水平变化比较
李晓丽,邢秀月,周叶,王丽娜,徐川微
0
(琼海市人民医院妇科)
摘要:
【摘要】 目的 探讨腹腔镜全子宫切除术联合双侧输卵管切除术对绝经前期患者血清抗缪勒管激素(AMH)和卵巢功能的影响。方法 选取2015年1月~2017年1月琼海市人民医院妇科接受腹腔镜全子宫切除术治疗的168例子宫良性疾病患者作为研究对象,采用回顾性分析法分析其临床资料,保留双侧输卵管者设为对照组,切除双侧输卵管者设为观察组,每组各84例,观察组和对照组又按年龄分为 ≥45岁组和<45岁组。比较观察组与对照组手术情况、黄体生成素(LH)、卵泡雌激素(FSH)、雌二醇(E2)、AMH、围绝经期症状发生率、输卵管病变以及盆腔包裹性积液发生率。结果 两组手术时间、术中出血量、肛门排气时间和住院时间比较差异无统计学意义(P>0.05);两组术后1、3、6个月LH、FSH均明显高于术前,E2水平均明显低于术前(P<0.05),但观察组与对照组术后1、3、6个月LH、FSH、E2水平比较差异均无统计学意义(P>0.05);<45岁观察组术后1、3、6个月AMH水平均明显低于<45岁对照组(P<0.05) ;≥45岁观察组术后1、3、6个月AMH水平与≥45岁对照组比较差异均无统计学意义(P>0.05);两组术后1、3、6个月围绝经期症状发生率比较差异均无统计学意义(P>0.05);观察组输卵管病变发生率、盆腔包裹性积液发生率均明显低于对照组(P<0.05)。结论 腹腔镜全子宫切除术联合双侧输卵管切除术可预防绝经前期子宫良性疾病患者盆腔包裹性积液的发生,与单纯腹腔镜全子宫切除术对患者的卵巢功能、围绝经期症状发生率的影响相似,但在不同年龄组对患者卵巢储备功能的影响有所不同,临床医师应根据患者的年龄及卵巢状况选择手术方式。
关键词:  绝经前期  腹腔镜  子宫切除术  双侧输卵管切除术  血清抗苗勒管激素  卵巢功能
DOI:
基金项目:
Comparison of AMH levels in premenopausal women undergoing laparoscopic panhysterectomy with bilateral salpingectomy or panhysterectomy
LI Xiaoli,XING Xiuyue,ZHOU Ye,Wang Lina,XU Chuanhui
(Qionghai People's Hospital)
Abstract:
【Abstract】 Objective To investigate the effect of laparoscopic panhysterectomy with bilateral salpingectomy on the serum antimullerian hormone (AMH) and ovarian function of premenopausal women. Methods The clinical data of 168 patients with benign uterine diseases treated by laparoscopic panhysterectomy in Qionghai People's Hospital between January 2015 and January 2017 were retrospectively analyzed. Patients were divided into the observation group and the control group, each with 84 cases. The observation group and the control group were divided ≥45 years group and<45 years group by age. The control group preserved bilateral fallopian canal, and the observation group underwent simultaneously bilateral fallopian tube resection. The surgical conditions, luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol (E2), AMH, ovarian arterial blood supply, perimenopausal symptoms, tubal lesions, and incidence rate of pelvic encapsulated fluid were compared. Results There was no significant difference in operation time, intraoperative blood loss, anus exhaust time and hospital stay between the two groups (P>0.05). At postoperative 1mon, 3mon and 6mon, the LH and FSH levels were increased significantly, E2 and AMH levels were decreased significantly (P<0.05), and no difference was found in the above levels between groups (P>0.05). The level of AMH at 1, 3 and 6 months after operation in the observation group of<45 years was significantly lower than that in the control group of<45 years old (P<0.05), and there was no significant difference in the level of AMH between the 1, 3 and 6 months after the operation in the observation group of 45 years old and that of the control group with the age of 45 years old (P>0.05). There was no significant difference in the incidence of perimenopausal symptoms between the two groups at 1 month, 3 months, and 6 months after operation (P>0.05). The incidence of fallopian tube lesions and pelvic encapsulated fluid in the observation group were significantly lower than those in the control group (000% vs 1905%, 357% vs 1667%, P<0.05). Conclusion Compared with the panhysterectomy, laparoscopic panhysterectomy with bilateral salpingectomy can prevent the incidence of and pelvic encapsulated fluid, while the effect on the ovarian function, AMH, ovarian artery blood supply and perimenopausal symptoms are similar.
Key words:  Premenopause period  Laparoscopic  Panhysterectomy  Bilateral salpingectomy  Serum AMH  Ovarian function

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