目的 通过检测血清AMH(anti-Miillerian hormone)水平及术后改良Kupperman评分探讨子宫肌瘤不同手术方式对卵巢功能近期和远期的影响。方法 选择2014年1月—2015年7月因子宫肌瘤需手术的患者120例,分为子宫肌瘤切除组(A组,n=40),全子宫切除组(B组,n=40),全子宫加双侧输卵管切除组(C组,n=40),分别检测并比较三组患者术前2 d、术后1、6、12个月的血清AMH水平,同时在相应节点用改良Kupperman评分评估围绝经期症状的严重程度。结果 B组、C组术后6个月、术后12个月与术前2 d相比,AMH水平均明显降低(P＜0.05);组间比较:相对于A组,B、C组术后6个月,术后12个月 AMH明显降低(P＜0.05)。与术前2 d相比,B组、C组术后1个月评分均无明显变化(P＞0.05),术后6个月和术后12个月评分明显升高(P＜0.05);相对于A组,B、C组术后6个月和术后12个月评分明显升高(P＜0.01)。结论 子宫肌瘤切除术对卵巢功能影响较小,而临床效果与子宫次全切除术基本相当,全子宫切除术患者及全子宫加双侧输卵管切除患者术后6、12个月卵巢功能减退明显,在满足手术适应证的前提下,可首选子宫肌瘤切除术治疗子宫肌瘤,降低对卵巢功能的影响。

Objective To evaluate the short-term and long-term effects of different surgical methods for uterine myoma on ovarian function by detecting the serum levels of AMH and postoperative modified Kupperman score.Methods From January 2014 to July 2015, 120 uterine fibroids patients underwent surgery, including uterine myomectomy group (group A, n=40), hysterectomy group (group B, n=40), and hysterectomy plus bilateral tubal resection group (group C, n=40). Serum AMH levels were detected and compared among the three groups before 2 days of surgery and after 1, 6, and 12 months of surgery, and modified Kupperman scores at corresponding time points were also detected to assess the severity of perimenopausal symptoms.Results For group B and group C, AMH levels were significantly lower at postoperative 6 and 12 months than preoperative 2 days (P<0.05). Compared with group A, group B and group C showed significantly lower levels of AMH at postoperative 6 and 12 months (P<0.05). For group B and group C, modified Kupperman score did not change at postoperative 1 month (P>0.05), but increased significantly at postoperative 6 and 12 months (P<0.05) compared with preoperative 2 days. Compared with group A, group B and group C showed higher modified Kupperman scores at postoperative 6 and 12 months (P<0.01).Conclusion Myomectomy (control group) has little effects on ovarian function, but its clinical effect is comparable to subtotal hysterectomy. The patients receiving hysterectomy or hysterectomy with bilateral tubal resection result in decreased ovarian function at postoperative 6 and 12 months. Therefore, myomectomy is a preferred treatment for uterine myoma without affecting ovarian function.