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目的:通过比较行子宫切除保留卵巢与未进行子宫切除绝经前妇女的卵巢功能,评估子宫切除后卵巢功能早衰风险。方法:选取解放军总医院妇产科2004～2007年收治的120例因患女性生殖系统良性疾病接收全子宫切除保留双侧卵巢的妇女为手术组,及135例未行子宫切除的绝经前妇女为对照组,每年对纳入对象进行血清检测以及问卷调查,详细记录数据4年。以血清FSH>40 U/L为发生卵巢功能衰退,以危险率描述发生卵巢功能早衰的风险,利用COX比例风险模型进行统计学分析。结果:接受全子宫切除保留双侧卵巢的妇女中有20例(16.67%)发生卵巢功能早衰,对照组有15例(11.11%)发生卵巢功能早衰,具有统计学差异。与对照组相比,手术组发生卵巢衰竭的HR值1.92(95%CI 1.29~2.86,P<0.01),其中单纯子宫切除的患者发生卵巢衰竭的HR值1.74(95%CI 1.14~2.65,P<0.05),全子宫并附带单侧卵巢切除的妇女发生卵巢早衰的HR值2.93(95%CI 1.57~5.49,P<0.01)。结论:绝经前子宫切除可能增加发生卵巢功能早衰的风险,但其导致卵巢功能早衰的原因尚不明确,手术或子宫基础疾病均可能参与了卵巢功能早衰的发生。
OBJECTIVE: To assess the risk of premature ovarian failure after hysterectomy by comparing the ovarian function between women who have undergone hysterectomy with preserved ovaries and those who have not undergone hysterectomy. METHODS: A total of 120 women who received total hysterectomy and bilateral ovaries for the treatment of benign diseases of the female reproductive system admitted to the Department of Obstetrics and Gynecology, PLA General Hospital from 2004 to 2007 were selected as the operation group and 135 premenopausal women who did not undergo hysterectomy In the control group, serum samples and questionnaires were included in the survey every year, and the data were recorded in detail for 4 years. Ovarian function decline occurred at a serum FSH> 40 U / L, risk of premature ovarian failure was described by hazard ratio, and COX proportional hazards model was used for statistical analysis. Results: 20 cases (16.67%) of women who underwent hysterectomy retained bilateral ovaries had premature ovarian failure, and 15 cases (11.11%) of control group had premature ovarian failure, with statistical difference. Compared with the control group, the HR of ovarian failure in the operation group was 1.92 (95% CI 1.29-2.86, P <0.01). The HR of ovarian failure in patients with simple hysterectomy was 1.74 (95% CI 1.14-2.65, P <0.05). The HR of premature ovarian failure was 2.93 (95% CI 1.57-5.49, P <0.01) in women who underwent uterine dissection and unilateral ovariectomy. CONCLUSION: Premenopausal hysterectomy may increase the risk of premature ovarian failure, but its cause of premature ovarian failure is not yet known. Surgical or uterine underlying diseases may be involved in the development of premature ovarian failure.