腹腔镜下保留子宫动脉全子宫切除术的临床对照研究-《中国微创外科杂志》

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Title:: Controlled Study on Efficacy of Laparoscopic Hysterectomy with Preservation of the Uterine Artery

作者:: 陈露诗; 李光仪; 韩玉斌; 关锦图; 吴菲; 张肖怡; 广东省佛山市第一人民医院妇产科，佛山528000

Author(s):: Chen Lushi; Li Guangyi; Han Yubin; et al.; Department of Obstetrics and Gynecology, First Renmin Hospital, Foshan 528000, China

关键词:: 腹腔镜; 子宫切除术; 子宫动脉; 卵巢功能

Keywords:: Laparoscopy; Hysterectomy; Uterine artery; Ovarian function

分类号:: R713.4+2

文献标志码:: A

摘要:: 目的探讨腹腔镜下保留子宫动脉全子宫切除术对卵巢功能影响的临床价值。方法符合入选标准的60例全子宫切除术，按入院先后顺序（奇偶数）分成腹腔镜下保留子宫动脉全子宫切除术30例（研究组），腹腔镜下常规全子宫切除术30例（对照组），观察两组手术指标、手术前后血清性激素变化、围绝经期症状的发生率和改良Kupperman评分情况。结果研究组与对照组比较，手术时间、术中出血量、术后病率差异无显著性（P＞0.05），2组均无手术并发症。血清性激素（E2、FSH、LH）术前两组比较差异无显著性（P＞0.05），术后6个月，研究组E2明显高于对照组［（144.20±65.45）ng/L vs（98.49±51.83）ng/L，t=2.999，P=0.004］，FSH、LH明显低于对照组［FSH：（6.24±2.52）IU/L vs（9.67±3.13）IU/L，t=-4.678，P=0.000；LH：（7.62±2.48）IU/L vs（8.96±2.49）IU/L，t=-2.084，P=0.042］。与术前比较，研究组术后6个月E2虽有降低，FSH、LH虽有所升高（2例FSH＞10 IU/L），差异均无显著性（P＞0.05）；对照组术后6个月E2明显降低，FSH、LH明显升高，差异有显著性（P＜0.01），且12例FSH＞10 IU/L，1例FSH＞40 IU/L，E2＜30 ng/L，呈绝经期激素改变。结论腹腔镜下保留子宫血管全子宫切除术微创、安全、可行，且较大限度地保存了子宫切除患者近期的卵巢功能，其远期的临床效果仍需深入研究。

Abstract:: ObjectiveTo investigate the efficacy of laparoscopic hysterectomy with preservation of the uterine artery.MethodsTotally 60 premenopausal women with benign uterine diseases were included in this study. Among them, 30 received laparoscopic hysterectomy with preservation of the uterine artery (study group), and 30 underwent standard laparoscopic hysterectomy (control group). The ovarian function and perimenopause syndromes, as well as modified Kupperman scores of the two groups were compared after the operations.ResultsNo statistical significant differences were found in operation time, intraoperative blood loss, and postoperative morbidity (P＞005). None of the patients had surgeryrelated complications. Before the operation, no significant difference was found in the levels of E2, FSH, and LH between the two groups (P＞0.05). Six months after the operation, the level of E2 in the study group was significantly higher than that in the control group ［（144.20±65.45) ng/L vs (98.49±51.83)ng/L, t=2.999, P=0.004］; while the levels of FSH and LH in the study group were significantly lower than those in the control ［FSH：(6.24±2.52) IU/L vs (9.67±3.13) IU/L, t=-4.678, P=0.000； LH：(7.62±2.48)IU/L vs (8.96±2.49)IU/L, t=-2.084, P=0.042］. In the study group, the level of E2 decreased, and FSH and LH increased after the operation, but the changes were not significant (FSH ＞10 IU/L in 2 cases). Whereas, in the control group, the level of E2 decreased significantly after the surgery while the levels of FSH and LH increased significantly (P＜0.01, FSH ＞10 IU/L in 12 cases, FSH＞40 IU/L in one, and E2＜30 ng/L indicating menopause.ConclusionsLaparoscopic hysterectomy with preservation of the uterine artery is safe and feasible. As the procedure preserves the ovarian function of the patients, it can improve the life quality of the patients. Further study is necessary to determine the longterm effect of the treatment.

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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

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