| ObjectivesBy comparing the total hysterectomy and total hysterectomy + bilateral adnexectomy preoperative serum sex hormone levels,Kupperman score,postoperative changes of TCM syndrome and TCM syndrome types,evaluation of total hysterectomy and total hysterectomy+ bilateral adnexectomy influence on ovarian function,for perimenopausal women ovarian hysterectomy when resection provides the theory basis;The change characteristics of preoperative and postoperative syndromes and TCM syndromes of the two groups were compared to lay a theoretical foundation for TCM syndrome differentiation to improve the body state after hysterectomy and give full play to the advantages of TCM.MethodsSelected patients who underwent total hysterectomy and total hysterectomy in the gynecological ward of the Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from October 2019 to December 2020 due to benign diseases.The levels of serum FSH,LH,E2,and AMH were monitored 1 day before operation,7 days after operation,and 2 months after operation in the two groups of patients,and Kupperman score and TCM syndrome score were performed.Results1.A total of 77 patients were collected,and 3 patients diagnosed as ovarian malignant tumor due to intraoperative pathology were excluded.A total of 74 eligible patients were included,including 46 in the total hysterectomy group and 28 in the total hysterectomy +bilateral adnexectomy group.There were no significant differences between the two groups in age,BMI,occupation,marital status,educational level,menstruation,pregnancy,delivery,number of abortions,hospital diagnosis,combined internal and surgical diseases,surgical indications,operative time,surgical anesthesia,intraoperative blood loss,blood transfusion volume,postoperative diagnosis and other aspects(P > 0.05).2.The preoperative serum FSH,LH,E2,AMH levels and Kupperman score were not significantly different between the two groups of patients(P>0.05);at 7 days and 2 months after surgery,the serum FSH of the bilateral adnexectomy group was(34.51±13.49).,65.81±16.87 m IU/ml),LH(24.13±9.40 m IU/ml,35.27±9.17 m IU/ml)level,Kupperman score(10.39±2.99,18.93±1.63)were significantly higher than the total hysterectomy group(21.27±10.92 m IU/ml,17.82±6.56 m IU/ml;14.25±8.52 m IU/ml,12.67±5.19 m IU/ml;5.83±2.64,4.96±1,93(all P<0.05),serum E2(10.48±7.34pg/ ml,6.57±2.68pg/ml),AMH(0.147±0.123ng/ml,0ng/ml)levels were significantly lower than those in the total hysterectomy group(76.80±57.80pg/ml,84.97±69.85pg/ml;0.320±0.274 ng /ml,0.418±0.326ng/ml)(P<0.05);3.In the total hysterectomy group,serum FSH(21.27±10.92 m IU/ml,17.82±6.56 m IU/ml)and LH levels(14.25±8.52 m IU/ml,12.67±5.19 m IU/ml)7 days and 2 months after surgery)And Kupperman score(5.83±2.64,4.96±1.93)were significantly higher than1 day before surgery(12.68±8.78 m IU/ml,9.35±5.23 m IU/ml,2.33±1.80)(all P<0.05),serum E2(76.80 ±57.80pg/ml,84.97±69.85pg/ml),and AMH levels(0.320±0.274ng/ml,0.418±0.326ng/ml)were significantly lower than one day before surgery(134.89±97.61pg/ml,0.674±0.628ng/ ml)(all P<0.05);serum FSH(17.82±6.56 m IU/ml),LH level(12.67±5.19 m IU/ml),Kupperman score(4.96±1.93)at 2 months after operation were compared with those at 7 days after operation(21.27 ±10.92 m IU/ml,14.25±8.52 m IU/ml,5.83±2.64)slightly decreased,the difference was not statistically significant(P>0.05),serum E2(84.97±69.85pg/ml),AMH level(0.418±0.326ng)/ml)compared with 7 days after operation(76.80±57.80pg/ml,0.320±0.274ng/ml),the difference was not statistically significant(P>0.05);4.In the total hysterectomy group,serum FSH(34.51±13.49 m IU/ml,65.81±16.87 m IU/ml)and LH level(24.13±9.40 m IU/ml,35.27±9)7 days and 2 months after surgery,17 m IU/ml)and Kupperman scores(10.39±2.99,18.93±1.63)were significantly higher than 1 day before surgery(14.05±11.38 m IU/ml,10.98±8.98 m IU/ml,2.43±2.03)(all P<0.05),Serum E2(10.48±7.34pg/ml,6.57±2.68pg/ml)and AMH levels(0.147±0.123ng/ml,0ng/ml)were significantly lower than the day before surgery(121.12±98.51pg/ml,0.544±0.484ng)/ml,2.43±2.03)(all P<0.05);serum FSH(65.81±16.87 m IU/ml),LH level(35.27±9,17 m IU/ml)and Kupperman score(18.93±1.63)were significant at 2 months after operation Higher than 7 days after operation(34.51±13.49 m IU/ml,24.13±9.40 m IU/ml,10.39±2.99)(P<0.05),serum E2(6.57±2.68pg/ml)and AMH(0ng/ml)levels were significant Less than 7 days after operation(10.48±7.34pg/ml,0.147±0.123ng/ml)(P<0.05);5.The 74 patients included in this study were analyzed by preoperative syndrome differentiation,and a total of 5 TCM syndrome types were obtained: 6 cases of liver and kidney yin deficiency syndrome,23 cases of spleen and kidney deficiency syndrome,36 cases of qi stagnation and blood stasis syndrome,and heart-kidney incompatibility There were 5cases of syndrome and 4 cases of kidney yin and yang deficiency.In the total hysterectomy group,there were 3 cases of liver and kidney yin deficiency,18 cases of spleen and kidney deficiency,20 cases of qi stagnation and blood stasis syndrome,3 cases of heart and kidney failure syndrome,and 2 cases of kidney yin and yang deficiency.In the total uterus bilateral adnexectomy group,there were 3 cases of liver and kidney yin deficiency,5 cases of spleen and kidney deficiency,16 cases of qi stagnation and blood stasis syndrome,3 cases of heart and kidney incompatibility,and 2 cases of kidney yin and yang deficiency.There was no statistical difference in the distribution of preoperative syndrome types between the two groups(P>0.05).The number of patients with deficiency of both spleen and kidney in the total hysterectomy group was significantly higher than that in the total hysterectomy group(P<0.05),and there was no statistical difference among the other syndrome types(P>0.05).The number of patients with liver and kidney yin deficiency,heart and kidney failure,and kidney yin and yang deficiency in the total uterus bilateral appendage group was significantly higher than that in the total hysterectomy group(P<0.05),and the number of patients with spleen and kidney deficiency Significantly lower than the total hysterectomy group(P<0.05),there was no statistical difference in the number of patients with Qi stagnation and blood stasis syndrome between the two groups(P>0.05).6.In the total hysterectomy group,there was no significant difference in the number of patients with liver and kidney yin deficiency syndrome among the three visits 1 day before surgery,7 days after surgery,and 2 months after surgery(P>0.05);spleen and kidney deficiency syndrome The number of patients in 2 months after operation was higher than that of 1 day before operation and 7 days after operation(P<0.05),and there was no statistical difference between 1 day before operation and 7 days after operation(P>0.05);Qi stagnation and blood stasis surgery The number of patients in the first day was significantly higher than that of 7 days after surgery and 2 months after surgery(P<0.01),and there was no statistical difference between 7 days after surgery and 2 months after surgery(P>0.05);The number of patients in the last 7 days was higher than that of 1 day before operation and 2 months after operation(P<0.05),and there was no statistical difference between 1 day before operation and2 months after operation(P>0.05);The number of patients on the 7th day was higher than the one day before the operation(P<0.05),and there was no statistical difference between 2months after the operation,7 days after the operation,and 1 day before the operation(P>0.05);In the total uterine bilateral adnexectomy group,the number of patients with liver and kidney yin deficiency and spleen and kidney deficiency were not statistically different between the three visits 1 day before surgery,7 days after surgery,and 2 months after surgery(P >0.05);the number of patients with Qi stagnation and blood stasis syndrome one day before surgery was significantly higher than that of 7 days after surgery and 2 months after surgery(P<0.01),and there was no statistical difference between 7 days after surgery and 2months after surgery(P >0.05);the number of patients 7 days after heart and kidney failure was higher than that of 1 day before surgery(P<0.05),and there was no statistical difference between 2 months after surgery,1 day before surgery,and 7 days after surgery(P >0.05);the number of patients with deficiency of both kidney and yin and yang syndromes 7 days after surgery and 2 months after surgery was higher than that of 1 day before surgery(P<0.05),and there was no statistical difference between 2 months after surgery and 7 days after surgery(P>0.05).7.There was no significant difference between the total hysterectomy group and the total uterus bilateral adnexectomy group in the total scores of TCM syndromes one day before the operation(7.37±1.47 vs 7.89±1.73)(P>0.05).There was a statistically significant difference in the total scores of TCM syndromes between the total hysterectomy group and the total bilateral adnexectomy group at 7 days and 2 months after surgery(P<0.05).The total scores of TCM syndromes in the total hysterectomy group were(13.39±4.25).;8.91±3.66)were significantly lower than the total uterine bilateral appendectomy group(18.64±6.67;23.43±7.91)(all P<0.05)8.In the total hysterectomy group,the total scores of TCM syndromes on the 7th day after surgery(13.39±4.25)were significantly higher than the 1 day before surgery(7.37±1.47)and 2 months after surgery(8.91±3.66)(P<0.01).The total score of TCM syndromes in February(8.91±3.66)was higher than that of the day before the operation(7.37±1.47)(P<0.05).Symptoms such as chest pain,abdominal distension,and abdomen pain alleviate 7days after surgery,and symptoms such as hot flashes,five upset fever,dizziness,waist and knee weakness,tinnitus,night sweats,heart palpitations,and other symptoms aggravate;dizziness and hot flashes in 2 months,Night sweats,dry skin,itchy skin,five upset and heat,dry mouth,dry mouth,palpitations and easy convulsions,symptoms of loose stools,appetite,waist and knees are aggravated;in the total uterine bilateral appendage resection group,7days after surgery(18.64)±6.67)and 2 months after surgery(23.43±7.91),the scores of TCM syndromes were significantly higher than that of 1 day before surgery(7.89±1.73)(P<0.01)and 2 months after surgery(23.43±7.91).The score was slightly higher than 7 days after operation(18.64±6.67),but there was no statistical difference between the two(P>0.05).Symptoms such as chest and hypochondriac pain,lower abdomen pain and other symptoms alleviated 7 days after operation,and symptoms such as tinnitus,dizziness,waist and knee weakness,hot flashes,night sweats,dry skin,palpitations,and insomnia and dreams aggravated;2 months after operation,waist and knees Symptoms such as soreness and weakness,five upset and fever,hot flashes,night sweats,dizziness,tinnitus,and frequent cold and heat are aggravated.Conclusions1.The incidence of perimenopausal symptoms after hysterectomy and ovariectomy is higher than that of patients with simple hysterectomy,and the perimenopausal symptoms of patients with ovariectomy appear earlier and the symptoms are more severe.Although hysterectomy alone has a negative impact on ovarian function in the early postoperative period,ovarian function begins to recover at 2 months after surgery.Therefore,it is necessary to perform hysterectomy for patients with benign diseases of premenopausal factor uterus as much as possible.The integrity of the ovarian structure is preserved to maintain the patient’s endocrine function,avoid premature perimenopausal syndrome,and ensure the patient’s quality of life.2.2.Gynecological patients with benign tumors have five types of TCM syndromes:liver and kidney yin deficiency,spleen and kidney deficiency,qi stagnation and blood stasis,heart and kidney failure,and kidney yin and yang deficiency.The preoperative TCM syndrome is Qi stagnation.Mainly blood stasis syndrome.After hysterectomy,the reproductive axis is unbalanced,blood is internally injured,spleen-qi is damaged,kidney-qi deficiency,Chong-Ren imbalance,manifested as spleen and kidney deficiency syndrome,weakness of waist and knees,appetite,mental fatigue and other symptoms aggravate.If the ovaries are removed at the same time,Chong and Ren will be further damaged,exhaustion of yin and essence,imbalance of yin and yang,deficiency of kidney qi involving heart,liver,spleen and other organs dysfunction,making clinical symptoms appear complex and diverse,forming a mixture of deficiency and excess Pathological changes,TCM syndromes are mainly based on kidney yin and yang deficiency and liver and kidney yin deficiency syndrome,hot flashes,five upset heat,dizziness,waist and knee weakness,tinnitus,night sweats,heart palpitations and other symptoms aggravate. |
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