Yang Xiang-Jun, Li Na, Fang Xiu-Li, Zhu Ming
Department of Obstetrics and Gynecology, Zhongshan Hospital, Affiliated to Xiamen University Educational Hospital of Fujian Medical University, Xiamen, China.
Zhonghua Yi Xue Za Zhi. 2007 Jan 2;87(1):20-2.
To explore the most reasonable operation mode for treatment of leiomyoma so as to protect the ovary function of the patients.
103 leiomyoma patients under the age of 49 received different operation: myomectomy (Group I, n = 33), subtotal hysterectomy (Group II, n = 30), and hysterectomy (Group III, n = 40). The levels of serum estradiol (E(2)), progesterone (P), luteinizing hormone (LH), and follicle stimulating hormone (FSH) were detected before operations and 3 and 6 months after operations. Sixty patients underwent color Doppler ultrasonography before and after hysterectomy or subtotal hysterectomy to measure the blood flow of ovary artery. The maximal systolic flow velocity (Vmax), end-diastolic minimal flow velocity (Vmin), resistance index (RI), and pulsatility index (PI) were calculated.
There were no significant differences in the levels of E(2), P, LH, and FSH before and after operation among the patients of Group I regardless of the age (all P > 0.05) The E(2) levels 6 months after operation of Group II and Group III were both significantly lower than those before operation (both P < 0.05), however, the P, LH, and FSH levels before and after operation were not significantly different in these 2 groups (all P > 0.05). The E(2) level 6 months after operation of the patients aged > or = 40 in group III decreased much more significantly to (362 +/- 252) pmol/L, with a greater statistical difference in comparison with that before operation, (567 +/- 417) pmol/L (P < 0.01). The values of Vmax and Vmin of the ovary artery 6 months after operation were: 0.24 +/- 0.04 m/s and 0.05 +/- 0.05 m/s respectively, both significantly lower than those before operation, (0.50 +/- 0.11 m/s and 0.17 +/- 0.24 m/s respectively, both P < 0.01). The values of RI and PI 6 months after operation were: 0.80 +/- 0.05 and 2.06 +/- 0.24 respectively, both significantly higher than those before operation (0.74 +/- 0.05 and 1.62 +/- 0.33 respectively, both P < 0.01).
Myomectomy doesn't influence the ovary function. Both subtotal hysterectomy and hysterectomy decrease the ovary blood flow and endocrine function 6 months after operations.
探讨治疗子宫肌瘤最合理的手术方式，以保护患者的卵巢功能。
103例49岁以下的子宫肌瘤患者接受了不同的手术：肌瘤切除术（I组，n = 33）、子宫次全切除术（II组，n = 30）和子宫全切除术（III组，n = 40）。于术前及术后3个月和6个月检测血清雌二醇（E₂）、孕酮（P）、黄体生成素（LH）和卵泡刺激素（FSH）水平。60例患者在子宫全切除术或子宫次全切除术前、后接受彩色多普勒超声检查，测量卵巢动脉血流。计算最大收缩期流速（Vmax）、舒张末期最小流速（Vmin）、阻力指数（RI）和搏动指数（PI）。
I组患者无论年龄大小，术前、后E₂、P、LH和FSH水平差异均无统计学意义（均P > 0.05）。II组和III组术后6个月E₂水平均显著低于术前（均P < 0.05），但这两组术前、后P、LH和FSH水平差异无统计学意义（均P > 0.05）。III组年龄≥40岁患者术后6个月E₂水平降至（362±252）pmol/L，与术前（567±417）pmol/L相比，差异有统计学意义（P < 0.01）。术后6个月卵巢动脉Vmax和Vmin值分别为：0.24±0.04 m/s和0.05±0.05 m/s，均显著低于术前（分别为0.50±0.11 m/s和0.17±0.24 m/s，均P < 0.01）。术后6个月RI和PI值分别为：0.80±0.05和2.06±0.24，均显著高于术前（分别为0.74±0.05和1.62±0.33，均P < 0.01）。
肌瘤切除术不影响卵巢功能。子宫次全切除术和子宫全切除术均会降低术后6个月的卵巢血流及内分泌功能。
