RESUMEN
To compare the effects of laparoscopic total or subtotal hysterectomy and myomectomy on ovarian reserve by measuring the serum level of anti-Mullerian hormone (AMH).A total of 96 patients with uterine fibroids underwent total laparoscopic hysterectomy (TLH group,n =32),laparoscopic subtotal hysterectomy (LSH group,n =31) and laparoscopic myomectomy (LM group,n =33).Changes in ovarian reserve were examined by measuring the level of AMH pre-operation and at 1 and 4 months post-operation.No significant differences existed in AMH in LM group[(1.42 ±0.65),(1.31 ±0.53) & (1.33 ±0.61) μg/L,P ＞ 0.05].The levels of AMH in both groups were significantly lower than those at pre-operation [(1.17 ± 0.11),(1.01 ±0.10),(0.48±0.54) & (1.18±0.93),(0.45 ±0.39),(0.14±0.0) μg/L,P＜0.001].The mean percentage decrease in AMH was lower in TLH group than that in LSH group at 4-month follow-up [(-37.4 ± 37.6) ％ vs.(-27.0 ± 23.0) ％,P =0.017].The results showed that LM had no effect on ovarian reserve.Both LSH and TLH had adverse effects on ovarian reserve and TLH was more marked.
RESUMEN
Objective To compare the clinical effect of preserving the ascending uterine artery in laparoscopic hysterectomy with traditional laparoscopic hysterectomy.Methods 112 patients with various kinds of uterine benign lesions performed by hysterectomy were randomly divided into the preserving the ascending uterine artery in laparoscopic hysterectomy group(observation group,n =60) and traditional laparoscopic hysterectomy group (control group,n =52),The operation time,the intra operative blood loss,the postoperative complications rate and the perimenopausal symptoms in two groups were compared as well as the levels of blood calcium and the levels of hormone before operation,the first month,the sixth month,the first year,and the third year after operation.Results The opreration time [(95.5 ± 22.8) win] and intraoperative blood soss [(81.3 ± 11.6) ml] of the observation group was more than those of the control group [(68.8 ± 7.2) ml] (t =3.772,4.418,all P ＜ 0.05).The postoperative abnormal uniation and defection (1.7％) and fever incidence (1.7％) of the observation group was lower than those of the control group (11.5 ％,13.5 ％) (x2 =4.623,5.843,all P ＜ 0.05).The estradiol level of the observation group began to fall in 6 months postoperative,and had significant differences compare with those of the control group 6 months,1 year,3 years after operation [(328.4 ± 13.4) pmol/L vs (304.8 ± 15.2) pmol/L,(311.3 ± 12.9) pmol/L vs (248.5 ±13.6)pmol/L,(258.3 ± 11.4)pmol/L vs (138.7 ± 12.7)pmol/L] (t =8.758,25.121,52.688,all P ＜0.05).There was significant difference in the level of follicle stimulating hormone (FSH) and luteinizing hormone (LH) between the two groups 1,3 years after operation(t =-90.540,-123.229,-14.757,-19.845,all P ＜ 0.01).There was significant difference in the level of calcium between the two groups 1,3 years after operation(t =3.261,3.050,all P ＜0.05).The perimenopausal symptoms of the observation group was less than those of the control group(x2 =6.142,3.471,4.976,6.646,4.633,all P ＜ 0.05).Conclusion Laparoscopic hysterectomy of preserving the ascending uterine artery is safe and reliable;the recently ovarian function of the patients with hysterectomy is to maximize the preservation in the treatment,the women's quality of life will be to improved.