Effect of hysterectomy and oophorectomy on the menopausal symptoms of women
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摘要:
目的 探讨子宫切除术、子宫及卵巢切除术对女性绝经症状的影响。 方法 对未行子宫切除的志愿者和子宫及/或卵巢切除术后回医院复诊的病人检测其血清卵泡刺激素（FSH）水平；同时采用改良的Kupperman评分表对其绝经症状进行评估；比较未行手术组、单纯子宫切除组、子宫切除+单侧卵巢切除组、子宫切除+双侧卵巢切除组4组之间绝经症状的差异。 结果 3组手术组Kupperman总分均高于未行手术组，差异有统计学意义（P<0.001）。经两两比较，子宫切除+双侧卵巢切除组Kupperman总分高于单纯子宫切除组（P<0.001）；其余组间差异无统计学意义。采用多组间的Ridit检验法比较4组绝经症状严重程度的差异，结果与Kupperman总分的比较结果一致。3组手术组血清FSH值均高于未行手术组，差异有统计学意义（P=0.005）。手术组两两比较，子宫切除+双侧卵巢切除组血清FSH值高于单纯子宫切除组（P=0.011）和子宫切除+单侧卵巢切除组（P<0.001），单纯子宫切除组与子宫切除+单侧卵巢切除组差异无统计学意义（P>0.05）。 结论 子宫切除术的手术范围、术后绝经症状表现与血清FSH值存在相关性，子宫及卵巢切除术可加速FSH值上升，加重绝经症状。 -
关键词:
- 子宫切除术 /
- 卵巢切除术 /
- 绝经症状 /
- 改良Kupperman评分 /
- 血清FSH值
Abstract:Objective To investigate the effect of hysterectomy and oophorectomy on the menopausal symptoms of women. Methods 131 women who received hysterectomy and/or oophorectomy in Tongji Hospital and 104 healthy volunteers in menopause were included, and their menopausal symptoms and concentration of serum follicle-stimulating hormone (FSH) were recorded. Results The KMI scores of hysterectomized group, hysterectomized + single oophorectomized group and hysterectomized + bilateral oophorectomized group were significantly higher than that of non-hysterectomized group (P<0.001). The KMI score of the hysterectomized+ bilateral oophorectomized group was markedly higher than that of hysterectomized group (P<0.001). There were no statistically differences between other operation groups. The Ridit test results showed no significant differences in the severity of menopausal symptoms between 4 groups, which was consistent with the comparison results of KMI scores. The statistical results of concentration of serum FSH were as follows: the concentration of serum FSH of three hysterectomized groups were significantly higher than that non-hysterectomized group (P=0.005); that of hysterectomized + bilateral oophorectomized group was higher than that of hysterectomized group (P=0.011) and that of hysterectomized + single oophorectomized group (P<0.001). There were no statistically significant differences in the concentration of serum FSH between hysterectomized group and hysterectomized+ single oophorectomized group. Conclusion We found there was a correlation between postoperative menopausal symptoms and serum FSH value after hysterectomy. Hysterectomy and ovarian resection could accelerate the increase of FSH value and aggravate menopausal symptoms. -
表 1 4组女性Kupperman总分比较（Mean±SD，分）
组别 Kupperman总分 F P 未行手术组 1.58±1.04 27.516 <0.001 单纯子宫切除组 5.50±1.95* 子宫切除+单侧卵巢切除组 6.36±1.60* 子宫切除+双侧卵巢切除组 10.29±2.99*# *P<0.05vs未行子宫切除组; #P<0.05vs 单纯子宫切除组. 
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表 2 4组女性Kupperman各项得分比较（Mean±SD，分）
症状 未行子宫切除组 单纯子宫切除组 子宫切除+单侧卵巢切除组 子宫切除+双侧卵巢切除组 F P 潮热出汗 0.04±0.20 0.58±0.85* 0.93±1.21* 1.10±0.98*# 26.619 <0.001 感觉异常 0.01±0.10 0.00±0.00 0.00±0.00 0.12±0.45* 3.001 0.032 失眠 0.26±0.46 0.21±0.54 0.34±0.36 0.67±0.93*#▲ 5.949 0.001 焦躁 0.27±0.49 0.54±0.77 0.50±0.85 0.48±0.80 2.373 0.071 抑郁 0.10±0.33 0.10±0.31 0.00±0.00 0.12±0.45 0.433 0.729 头晕 0.37±0.51 0.27±0.71 0.36±0.63 0.64±0.91 2.580 0.055 疲乏 0.20±0.42 0.50±0.85 0.57±0.94 0.95±0.94*# 11.854 <0.001 关节痛 0.08±0.27 0.31±0.66 0.39±0.61 0.57±0.97* 7.086 <0.001 头痛 0.05±0.39 0.00±0.00 0.00±0.00 0.15±0.22* 3.717 0.012 心慌 0.04±0.20 0.10±0.47 0.00±0.00 0.14±0.52 1.123 0.341 皮肤蚁走感 0.01±0.10 0.15±0.36 0.00±0.00 0.14±0.52* 3.379 0.019 性交痛 0.01±0.10 0.44±0.65* 0.43±0.65* 0.26±0.66* 10.705 <0.001 泌尿系症状 0.07±0.26 0.08±0.35 0.29±0.47 0.14±0.42 2.015 0.113 *P<0.05vs未行子宫切除组; #P<0.05vs子宫切除组; ▲P<0.05vs子宫切除+单侧卵巢切除组.
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表 3 绝经症状严重程度比较[n（%）]
组别 正常 轻度 中度 重度 Ridit值 P 未行手术组 102（98.1） 2（1.9） 0（0.0） 0（0.0） 0.160 <0.001 单纯子宫切除组 30（62.5） 11（22.9） 7（14.6） 0（2.0） 0.286* 子宫切除+单侧卵巢切除组 29（70.7） 3（7.3） 9（22.0） 0（0.0） 0.267* 子宫切除+双侧卵巢切除组 18（42.9） 10（23.8） 13（30.9） 1（2.4） 0.340*# *P<0.05vs未行子宫切除组; #P<0.05vs单纯子宫切除组.
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表 4 4组女性血清FSH值（Mean±SD）
组别 FSH（mU/mL） P 未行手术组 9.55±3.41 0.005 单纯子宫切除组 14.72±4.11* 子宫切除+单侧卵巢切除组 16.59±3.94* 子宫切除+双侧卵巢切除组 25.02±4.53*#▲ *P<0.05vs未行子宫切除组; #P<0.05vs单纯子宫切除组; ▲P<0.05vs 子宫切除+单侧卵巢切除组; FSH: 血清卵泡刺激素.
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