基层医院开展腹腔镜下子宫全切术的可行性探讨
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摘要
目的探究腹腔镜下子宫全切除手术对患者卵巢内分泌功能的影响。方法收集2016年1月～2018年1月我院妇科良性子宫疾病患者60例,采用SPSS18.0将入组患者按先后序列号(1～60)随机分为两组:观察组(30例)与对照组(30例)。对照组给予传统开腹子宫切除术治疗;观察组给予腹腔镜下子宫全切除手术治疗,对两组患者治疗前后的卵巢内分泌功能变化情况以及性功能评分进行综合评价。结果和治疗前相比,对照组患者治疗后的雌二醇水平显著降低,差异有统计学意义(P <0.05),卵泡刺激素、促黄体生成素水平均显著升高,差异有统计学意义(P <0.05),但观察组患者治疗前后的雌二醇、卵泡刺激素、促黄体生成素水平之间的差异均无统计学意义(P> 0.05);治疗后和对照组相比,观察组患者的雌二醇水平显著升高,差异有统计学意义(P <0.05),卵泡刺激素、促黄体生成素水平均显著降低,差异有统计学意义(P <0.05),但治疗前两组患者的雌二醇、卵泡刺激素、促黄体生成素水平之间的差异均无统计学意义(P> 0.05)。两组患者术前、术后3个月、术后6个月性功能评分均逐渐升高,差异有统计学意义(P <0.05);术后3个月、术后6个月观察组患者性功能评分均显著高于对照组,差异有统计学意义(P <0.05),但术前两组患者的性功能评分之间的差异无统计学意义(P> 0.05)。结论腹腔镜下子宫全切除手术对患者卵巢内分泌功能影响较开腹手术小,能够促进患者性功能恢复,疗效显著,值得推广应用。
Objective To explore the effect of laparoscopic total hysterectomy on ovarian endocrine function of patients.Methods 60 patients with benign uterine diseases in department of gynecology in our hospital from January 2016 to January2018 were selected. According to sequence numbers(1-60),they were randomly divided into the observation group(30 cases) and control group(30 cases).The control group was treated with traditional open hysterectomy while the observation group was treated with laparoscopic hysterectomy.The ovarian endocrine function and sexual function scores before and after treatment of patients in two groups were evaluated. Results The level of estradiol after treatment in the control group was significantly lower than that before treatment,and the difference was statistically significant(P < 0.05).The levels of follicle stimulating hormone and luteinizing hormone were significantly increased,and the difference was statistically significant(P< 0.05).There was no significant difference in estradiol,follicle stimulating hormone and luteinizing hormone levels between the observation group before and after treatment(P > 0.05).Compared with the control group,the estradiol level after treatment in the observation group was significantly increased,and the difference was statistically significant(P < 0.05).The levels of follicle stimulating hormone and luteinizing hormone were significantly decreased, and the difference was statistically significant(P < 0.05).However,there were no statistically significant differences in estradiol,folliclestimulating hormone and luteinizing hormone levels between the two groups before treatment(P > 0.05).The scores of sexual function in the two groups were increased gradually before operation,3 months after operation and 6 months after operation, and the difference was statistically significant(P < 0.05).The scores of sexual function in the observation group were significantly higher than those in the control group at 3 months and 6 months after operation(P < 0.05).However,there was no significant difference in the scores of sexual function between the two groups before operation(P > 0.05). Conclusion Laparoscopic total hysterectomy has a smaller effect on ovarian endocrine function than laparotomy,which can promote the recovery of sexual function in patients.The curative effect is significant and it is worthy of promotion and application.
Objective To explore the effect of laparoscopic total hysterectomy on ovarian endocrine function of patients.Methods 60 patients with benign uterine diseases in department of gynecology in our hospital from January 2016 to January2018 were selected. According to sequence numbers(1-60),they were randomly divided into the observation group(30 cases) and control group(30 cases).The control group was treated with traditional open hysterectomy while the observation group was treated with laparoscopic hysterectomy.The ovarian endocrine function and sexual function scores before and after treatment of patients in two groups were evaluated. Results The level of estradiol after treatment in the control group was significantly lower than that before treatment,and the difference was statistically significant(P < 0.05).The levels of follicle stimulating hormone and luteinizing hormone were significantly increased,and the difference was statistically significant(P< 0.05).There was no significant difference in estradiol,follicle stimulating hormone and luteinizing hormone levels between the observation group before and after treatment(P > 0.05).Compared with the control group,the estradiol level after treatment in the observation group was significantly increased,and the difference was statistically significant(P < 0.05).The levels of follicle stimulating hormone and luteinizing hormone were significantly decreased, and the difference was statistically significant(P < 0.05).However,there were no statistically significant differences in estradiol,folliclestimulating hormone and luteinizing hormone levels between the two groups before treatment(P > 0.05).The scores of sexual function in the two groups were increased gradually before operation,3 months after operation and 6 months after operation, and the difference was statistically significant(P < 0.05).The scores of sexual function in the observation group were significantly higher than those in the control group at 3 months and 6 months after operation(P < 0.05).However,there was no significant difference in the scores of sexual function between the two groups before operation(P > 0.05). Conclusion Laparoscopic total hysterectomy has a smaller effect on ovarian endocrine function than laparotomy,which can promote the recovery of sexual function in patients.The curative effect is significant and it is worthy of promotion and application.
引文
[1]谢秋娴,杨纯,谢昭雄,等.腹腔镜全子宫切除术和腹腔镜次全子宫切除术对患者卵巢功能及其性功能的影响[J].中国性科学,2015,14(4):3-5.
[2]Yuan H,Wang C,Wang D,et al.Comparison of the effect of laparoscopic supracervical and total hysterectomy for uterine fibroids on ovarian reserve by assessing serum antiMullerian hormone levels:a prospective cohort study[J].JMinim Invasive Gynecol,2015,22(4):637-641.
[3]肖淑,郑新秋,欧海蔚,等.腹腔镜与开腹手术治疗老年良性卵巢肿瘤对患者免疫功能及神经内分泌功能的影响[J].海南医学院学报,2016,22(1):62-65.
[4]袁华,赵绍杰,龚华,等.腹腔镜下次全子宫与全子宫切除、肌瘤剔除术对子宫肌瘤患者卵巢储备功能的影响[J].中华全科医师杂志,2015,14(5):377-380.
[5]王红.腹腔镜全子宫切除术和腹腔镜次全子宫切除术对患者卵巢功能及其性功能的影响[J].中国计划生育和妇产科,2016,8(5):58-61.
[6]杨巧云,林俊.围术期心理护理对腹腔镜下子宫全切术患者性功能影响研究[J].中国现代医生,2015,53(8):124-127.
[7]林莉,许红雁.腹腔镜下子宫全切术对患者血液黏滞度与红细胞免疫状态的影响[J].海南医学院学报,2015,21(11):1519-1521.
[8]吴芬芬,董瑞兰.围术期心理护理干预对腹腔镜下子宫全切术患者性功能影响[J].中国卫生标准管理,2016,7(16):200-202.
[9]王雅迅.腹腔镜子宫全切术用于妇科良性肿瘤的效果及对机体免疫功能的影响[J].中国医药科学,2017,7(22):57-59.
[10]吴图雅,马美婧.腹腔镜下子宫全切术治疗子宫肌瘤的临床效果分析[J].转化医学电子杂志,2015,2(10):32-33.
[11]张碧云,罗小芳.腹腔镜下子宫全切术后患者碘伏阴道残端冲洗在预防术后感染中的效果分析[J].浙江临床医学,2016,18(12):2294-2295.
[12]Du J,Li JW,Jin J,et al.Intraoperative and postoperative infusion of dexmedetomidine combined with intravenous butorphanol patient-controlled analgesia following total hysterectomy under laparoscopy[J].Exp Ther Med,2018;16(5):4063-4069.
[13]Lepka P,J?dryka M,Misiek M,et al.Hysterectomy in Poland between 2011 and 2016.Changing trends in the surgical approach to hysterectomy[J].Ginekol Pol,2018,89(10):529-535.
[14]Ruan XC,Wong WL,Yeong HQ,et al.Comparison of outcomes following laparoscopic and open hysterectomy with pelvic lymphadenectomy for early stage endometrial carcinoma[J].Singapore Med J,2018,59(7):366-369.
[15]Yang W,Luo N,Ma L,et al.The Changes of Surgical Treatment for Symptomatic Uterine Myomas in the Past15 Years[J].Gynecol Minim Invasive Ther,2018,7(1):10-15.
[16]Morciano A,Marzo G,Caliandro D,et al.Laparoscopic sacral colpopexy and a new approach to mesh fixation:a randomized clinical trial[J].Arch Gynecol Obstet,2018,298(5):939-944.
[2]Yuan H,Wang C,Wang D,et al.Comparison of the effect of laparoscopic supracervical and total hysterectomy for uterine fibroids on ovarian reserve by assessing serum antiMullerian hormone levels:a prospective cohort study[J].JMinim Invasive Gynecol,2015,22(4):637-641.
[3]肖淑,郑新秋,欧海蔚,等.腹腔镜与开腹手术治疗老年良性卵巢肿瘤对患者免疫功能及神经内分泌功能的影响[J].海南医学院学报,2016,22(1):62-65.
[4]袁华,赵绍杰,龚华,等.腹腔镜下次全子宫与全子宫切除、肌瘤剔除术对子宫肌瘤患者卵巢储备功能的影响[J].中华全科医师杂志,2015,14(5):377-380.
[5]王红.腹腔镜全子宫切除术和腹腔镜次全子宫切除术对患者卵巢功能及其性功能的影响[J].中国计划生育和妇产科,2016,8(5):58-61.
[6]杨巧云,林俊.围术期心理护理对腹腔镜下子宫全切术患者性功能影响研究[J].中国现代医生,2015,53(8):124-127.
[7]林莉,许红雁.腹腔镜下子宫全切术对患者血液黏滞度与红细胞免疫状态的影响[J].海南医学院学报,2015,21(11):1519-1521.
[8]吴芬芬,董瑞兰.围术期心理护理干预对腹腔镜下子宫全切术患者性功能影响[J].中国卫生标准管理,2016,7(16):200-202.
[9]王雅迅.腹腔镜子宫全切术用于妇科良性肿瘤的效果及对机体免疫功能的影响[J].中国医药科学,2017,7(22):57-59.
[10]吴图雅,马美婧.腹腔镜下子宫全切术治疗子宫肌瘤的临床效果分析[J].转化医学电子杂志,2015,2(10):32-33.
[11]张碧云,罗小芳.腹腔镜下子宫全切术后患者碘伏阴道残端冲洗在预防术后感染中的效果分析[J].浙江临床医学,2016,18(12):2294-2295.
[12]Du J,Li JW,Jin J,et al.Intraoperative and postoperative infusion of dexmedetomidine combined with intravenous butorphanol patient-controlled analgesia following total hysterectomy under laparoscopy[J].Exp Ther Med,2018;16(5):4063-4069.
[13]Lepka P,J?dryka M,Misiek M,et al.Hysterectomy in Poland between 2011 and 2016.Changing trends in the surgical approach to hysterectomy[J].Ginekol Pol,2018,89(10):529-535.
[14]Ruan XC,Wong WL,Yeong HQ,et al.Comparison of outcomes following laparoscopic and open hysterectomy with pelvic lymphadenectomy for early stage endometrial carcinoma[J].Singapore Med J,2018,59(7):366-369.
[15]Yang W,Luo N,Ma L,et al.The Changes of Surgical Treatment for Symptomatic Uterine Myomas in the Past15 Years[J].Gynecol Minim Invasive Ther,2018,7(1):10-15.
[16]Morciano A,Marzo G,Caliandro D,et al.Laparoscopic sacral colpopexy and a new approach to mesh fixation:a randomized clinical trial[J].Arch Gynecol Obstet,2018,298(5):939-944.