【作者】 王凤霞；

【导师】 李楷滨； 冷宗祥；

【作者基本信息】 吉林大学 ， 妇产科学， 2005， 硕士

【摘要】 随着生活水平的日益提高,妇科手术对女性内分泌的影响越来越受到人们的关注,子宫肌瘤的手术方式一直是妇科医师争论的焦点。本文通过研究子宫肌瘤不同术式对女性内分泌的影响,探讨子宫、卵巢最合理的术式为维持女性内环境的稳定和术后的激素替代治疗提供参考。按子宫肌瘤病人不同术式分为4 组共80 例。分别于术前、术后不同时期测定体内激素水平。行子宫肌瘤剥出术的患者20 例:术后激素水平无变化,说明对女性内分泌无影响;行保留双侧附件的子宫切除术的患者20 例:术后1 周、8 周各激素水平无变化。术后24 周测定血中FSH、LH 值略升高,但与术前比较无显著性差异(P>0.05),E2值降低与术前比较有显著性差异(P<0.05),说明此种术式远期使卵巢功能有所减退甚至早衰;行保留单侧附件的子宫切除术的患者20 例:术后1 周E2值降低与术前比较有显著性差异(P<0.05),其它激素水平无变化。术后8 周、术后24 周测定血中FSH、LH 值升高,E2值降低与术前比较均有高度显著性差异(P<0.01)。可见保留一侧卵巢,不能很好地维持女性雌激素水平;行切除双侧附件的全子宫切除术的患者20 例:术后1 周E2值降低与术前比较有高度显著性差异(P<0.01),其它激素水平无变化,术更多还原

【Abstract】 Objective: To study the influence on the hormone level ofwomen with myoma of uterus after different operation of uterusand ovary, and to explore the most reasonable operative typesprovide basis for post-operation hormone replacement therapy.Methods: 80 female patients with myoma of uteruswere averagely divided into 4 groups according to the type ofoperation: groupⅠ: 20 patients with hysteromyomectomy; groupⅡ:20 patients with simple hysterectomy; groupⅢ:20 patients withhysterectomy plus uni-lateral adnexctomy; groupⅣ:20 patientswith hysterectomy plus bilateral adnexectomy. The level ofFSH 、LH、E2 、P、and T were detected respectively beforeoperation and in a week、8 weeks and 24 weeks after operation .Adopting the analyze system which named BECKMANCOUITER ACCESS ? made by USA. and BECKMAN reagent,measured the FSH 、LH、E2、P and T in serum by the method ofchemistry luminesce.Results: In groupⅠ, the hormone level showed no statisticaldifferences at a week、8 weeks and 24 weeks after operationcompared with pre-operation (P>0.05).In group Ⅱ, the hormonelevels of FSH、LH、E2 、P and T showed no statisticaldifferences at a week and 8 weeks after operation compared withpre-operation (P>0.05);the levels of FSH and LH increased butshowed no statistical differences at 24 weeks after operationcompared with pre-operation (P>0.05); and the level of E2declined and there were statistical differences at 24 weeks afteroperation compared with pre-operation (P<0.01); The levels of Pand T showed no statistical differences compared withpre-operation (P>0.05). In group Ⅲ, the hormone levels of FSH、LH 、P and T showed no statistical differences at a week andafter operation compared with pre-operation (P>0.05); the level ofE2 declined and there were statistical differences at a week afteroperation compared with pre-operation (P<0.05); the levels ofFSH and LH increased and the level of E2 declined and there werestatistical differences at 8 weeks and 24 weeks after operationcompared with pre-operation (P<0.01); The levels of P and Tshowed no statistical differences compared with pre-operation(P>0.05). In group Ⅳ: the hormone levels of FSH、LH 、P and Tshowed no statistical differences at a week and after operationcompared with pre-operation (P>0.05);the level of E2 declined andthere were statistical differences at a week after operationcompared with pre-operation (P<0.01); the levels of FSH and LHincreased and the level of E2 declined and there were statisticaldifferences at 8 weeks and 24 weeks after operation comparedwith pre-operation (P<0.01); The levels of P and T declined butshowed no statistical differences at 8 weeks and 24 weeks afteroperation compared with pre-operation (P>0.05). Conclusion: In hysteromyomectomy, the uterine artery wasremained and the blood supply of ovaries was adequate. Theovaries had normal functions. So patients of hysteromyomectoryhad no influence on hormones. In hysterectomy with both-sideovary remaining, because of the damage of the integration inanatomy between ovary and uterus,the blood supply of ovarieswas reduced, and the function of ovary were influenced. Therefore,the levels of hormones were reduced. In hysterectomy with更多还原