| BackgroundAbnormal uterine bleeding refers to the abnormal bleeding of the uterine, and should be distinguished with the bleeding from cervix, vagina, vulva, urinary tract, rectum and anus. As an easily seen symptom and sign in gynaecology, AUB severely affected women’s mental and physical health.The traditional treatment of benign AUB disease is curettage and drug-therapy. But each of them have defections and patients have poor compliance. However, large numbers of people have to undertake the radical hysterectomy due to the side effect of durg-therapy or the ineffective treatment. Quantities of researches have been made on the effect of surgical treatment on ovarian function. The former studies demonstrated that hysterectomy retaining ovary can maintain the normal hormone level and will not induce the hormone-defect disease. In contrast, as the knowledge of female reproductive endocrinology developed, recent studies have found that a premature ovarian failure would happen after the hysterectomy, and many literatures suggests the effect on ovarian function after hysterectomy. At present, minimally invasive surgery have become the mainstream and hysteroscopy have been used to treats various kinds of intrauterine lesions. Transcervical resection of endometrium, a minimally invasive treatment method for AUB caused by benign lesions on endometrium, which have the features of non-laparotomic, tiny wound, short duration, less bleeding, quicker recover, less complications and the retaining of uterine, is the priority in minimally invasive methods of the patients. However, as we all know, uterine is not only the target organ of the hormone, but also a complex endocrine organ, whose endocrine effect was through the endometrium cell functions. So, whether TCRE broke the female hypothalamic-pituitary-gonadal axis and disturb the balance between uterine and ovary, thus affect the ovarian function needs further research. At present, insufficient studys have been made on the effect of TCRE and hysterectomy on ovarian function, which will not help a lot in clinical invastigating.ObjectiveTo evaluate the influence on ovarian function after hysterectomy and transcervical resection of endometrium.Methods 1 Materials131 patients with AUB disease who undertake surgery treatment in our hospital was selected randomly, in which 113 cases have a complete follow-up(the lost rate was 13.7%). The ages and BMI value were compared in all the patients, and the difference have no statistical significance. The 113 patients with complete follow-up, average age(43.7±1.6) years, select surgery method according to their will. The 30 cases undertake TCRE refers to experimental group 1, average age(41.86±3.98) years, another 53 cases undertake a pure hysterectomy refers to experimental group 2, average age(43.9±1.9) years, while 39 cases who undertake hysterectomy with resection of bilateral oviduct refers to group 3,average age(43.0±1.5) years. All the patients have no menopausal symptoms, a bipolar BBT preoperation, two normal ovaries under transvaginal ultrasound and have no hormone treatment in recent 6 months. The preoperative hysteroscopy and pathological outcome confirmed benign in experimental group 1, while in group 2 and 3, bilateral ovaries were retained due to the normal size and color, and the pathological outcome postoperative proved benign. The data in the three groups are comparable. 2 MethodsThe operations were performed at the 8th-12 th days of the menstrual cycle in experimental groups. And the five hormone(FSH, LH, E2, P, T) levels were detected fastingly at the 2th-12 th days of the cycle preoperative. BBT, transvaginal ultrasound were tested at the 1, 3, 6month after the operation, and the hormone levels were detected again in those with a single-phase BBT and were at early follicular phase, to compare them before and after the operation.ResultsComparied with the blank control group, the p value of five hormone levels in three intervention groups before the surgery was more than 0.05, the difference has no statistical significance. The five hormone levels of the TCRE group were no changed and when compared with the preoperative, there still has no significant difference. After hysterectomy(including retain oviduct and resection of oviduct), the FSH and LH levels were all increased, while the E2 and P levels were decreased, T levels had no obvious changes, there was no significant difference between the preoperative and postoperative 1 months. But at 3 and 6 months, there was a significant difference compared with the preoperative P<0.05. Comparison of 5 hormone levels in the Hysterectomy(including retain oviduct and resection of oviduct) group at 1,3,6 months in between groups, there were all no significant difference. Compared with the TCRE group, the difference has no statistical significance after surgery 1 months, while the p values of FSH, LH, E2 at 3, 6 months after surgery were all more than 0.05. However, the P value of T levles was more than 0.05 and means there was no significant difference.ConclusionThe hysterectomy may cause ovarian function decline in premenopausal women and simultaneous resection of oviduct does not increase the influence of ovarian function in premenopausal women, the same effects can also be seen in the transcervica I resection of endometrium group. |
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