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目的探讨腹腔镜全子宫切除术同时预防性切除双侧输卵管的可行性及对卵巢功能和围绝经期症状的影响。方法选择因子宫良性疾病行腹腔镜子宫切除术的患者120例,其中同时行双侧输卵管切除术60例为观察组,保留双侧输卵管60例为对照组。观察两组患者手术时间、手术出血量、住院天数、术后肠道功能恢复情况、术后取尿管的时间、术前及术后血清性激素水平、围绝经期症状出现情况。结果 1观察组手术时间(126.39±36.34)min,术中出血量(84.56±53.66)ml,住院(5.34±1.73)d,术后取尿管(2.65±1.03)d,术后肠道功能恢复(37.67±14.25)h;对照组分别为(118.57±38.64)min、(76.84±60.28)ml、(5.81±2.19)d、(2.36±1.17)d、(34.29±12.54)h,两组比较差异无统计学意义(P>0.05)。2观察组术后E21 w、1、3月水平分别为(125.86±42.35)pmol/L、(114.78±36.83)pmol/L、(103.09±32.72)pmol/L,较术前(158.64±32.46)pmol/L显著降低(P<0.05);观察组术后FSH 1 w、1、3月水平分别为(11.24±4.16)m IU/L、(12.92±3.45)m IU/L、(15.07±4.62)m IU/L,LH水平分别为(12.65±3.93)m IU/L、(12.91±3.98)m IU/L、(15.42±4.21)m IU/L,与术前FSH(8.46±3.23)m IU/L、LH(7.86±3.52)m IU/L相比均显著升高(P<0.05);对照组术后上述性激素水平的变化趋势与观察组一致。3观察组术后1 w、1、3月围绝经期症状的发生率分别为25.00%(15/60)、36.66%(22/60)、41.6%(25/60),对照组分别为20.00%(12/60)、31.66%(19/60)、38.33%(23/60),差异无统计学意义(P>0.05)。结论腹腔镜全子宫切除时预防性双侧输卵管切除是一种安全、快速、必要的手术方式,对卵巢功能及围绝经期症状的影响不大,值得在术中应用。
Objective To investigate the feasibility of laparoscopic hysterectomy combined with preventive resection of bilateral fallopian tubes and its effects on ovarian function and perimenopausal symptoms. Methods A total of 120 patients with benign diseases of the uterus undergoing laparoscopic hysterectomy were selected, of whom 60 underwent bilateral salpingectomy at the same time as the observation group and 60 underwent bilateral fallopian tubes as the control group. The operation time, blood loss, days of hospitalization, recovery of postoperative intestinal function, duration of catheterization, preoperative and postoperative serum levels of sex hormones and perimenopausal symptoms were observed. Results 1 The operative time (126.39 ± 36.34) min, blood loss (84.56 ± 53.66) ml, hospitalization (5.34 ± 1.73) days, postoperative catheterization (2.65 ± 1.03) d, postoperative intestinal function recovery (37.67 ± 14.25) h in the control group and (118.57 ± 38.64) min in the control group (76.84 ± 60.28) ml and (5.81 ± 2.19) d respectively, (2.36 ± 1.17) d and (34.29 ± 12.54) h respectively No statistical significance (P> 0.05). (2) The levels of E21 w, 1, 3 in observation group were (125.86 ± 42.35) pmol / L, 114.78 ± 36.83 pmol / L and 103.09 ± 32.72 pmol / (P <0.05). The levels of FSH at 1 w, 1, 3 months after operation in the observation group were (11.24 ± 4.16) m IU / L, (12.92 ± 3.45) m IU / L, (15.07 ± 4.62 ) m IU / L and LH were (12.65 ± 3.93) m IU / L, (12.91 ± 3.98) m IU / L and (15.42 ± 4.21) m IU / IU / L and LH (7.86 ± 3.52) m IU / L, respectively (P <0.05). The trend of the sex hormones in the control group was the same as the observation group. The incidence of perimenopausal symptoms in the observation group was 25.00% (15/60), 36.66% (22/60) and 41.6% (25/60) respectively at 1 week, 1 month and 3 months after operation, while the control group was 20.00 % (12/60), 31.66% (19/60) and 38.33% (23/60), respectively, with no significant difference (P> 0.05). Conclusion Laparoscopic hysterectomy prophylactic bilateral tubal resection is a safe, rapid and necessary surgical method, the ovarian function and perimenopausal symptoms of little effect, it is worth applying in the surgery.