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目的动态观察子宫全切术和剔除术对子宫肌瘤患者卵巢功能的影响。方法选择40-48岁子宫肌瘤患者125例,76例行子宫全切术(全切组),49例行子宫肌瘤剔除术(剔除组),于术前、术后1、3、6、12、24个月测量雌二醇(E2)、卵泡刺激素(FSH)和黄体生成素(LH),采用非等距重复测量设计方差分析方法,评价性激素变化趋势。随访1-24个月,记录更年期症状发生的时间,Kaplan-Meier法进行生存分析。结果两组E2、FSH和LH不同时间点上的差异有统计学意义(P<0.01),表现为术后1个月E2下降,FSH和LH升高,手术3个月有向术前水平恢复的趋势,但均未达到术前水平。两组性激素水平随时间变化的趋势不同,组间效应差异显著(P<0.01),时间和分组因素存在交互效应(P<0.01)。剔除组24个月内更年期累计发生率曲线低于全切组,LogRank检验χ2=9.646,P=0.002。结论子宫肌瘤剔除术对患者性激素水平的影响程度小于子宫全切术,且可延缓更年期症状发生的时间,是治疗围绝经期子宫肌瘤患者的理想术式。
Objective To dynamically observe the effects of total hysterectomy and excision on ovarian function in patients with uterine fibroids. Methods Twenty-five patients with uterine leiomyoma at the age of 40-48 years were selected. 76 patients underwent hysterectomy (full-cut group). 49 patients underwent uterine myomectomy (exclusion group) before and after surgery. 1, 3, 6 Estradiol (E2), follicle stimulating hormone (FSH) and luteinizing hormone (LH) were measured at 12 and 24 months of age. Variability analysis was performed using non-equidistant repeated measures to assess the trend of sex hormones. Followed up for 1-24 months and recorded the time of menopausal symptoms. Kaplan-Meier method was used for survival analysis. Results There were significant differences in E2, FSH and LH at different time points between the two groups (P<0.01). The E2 decreased at 1 month after surgery, and the FSH and LH increased. There was a recovery to the preoperative level at 3 months after operation. The trends, but none have reached preoperative levels. The trends of sex hormone levels in the two groups were different with time, with significant differences between groups (P<0.01), and interaction effects between time and grouping factors (P<0.01). The cumulative incidence of menopause within 24 months was lower in the group than in the whole group. LogRank test χ 2 = 9.646, P = 0.002. Conclusion The effect of myomectomy on the level of sex hormone in patients is smaller than that of total hysterectomy, and it can delay the time of menopausal symptoms. It is an ideal surgical method for the treatment of patients with perimenopausal uterine fibroids.