不同方式全子宫切除术对女性性功能的影响

摘要

Objective To investigate the influence of total abdominal hysterectomy ( TAH ) , transvaginal hysterectomy ( TVH ) and laparoscopic total hysterectomy ( LTH) on female sexual function .Methods Altogether 60 patients with hysteromyoma treated with total hysterectomy in Huaian Tumor Hospital from December 2013 to December 2015 were enrolled in this study and divided into TAH group (n=23), TVH group (n=23) and LTH group (n=14) according to differenet operation methods .Patients in each group were further divided into two subgroups based on whether they under 48 years.All patients were followed up for 1 year, and sexual function score was measured by Female Sexual Function Index ( FSFI) .Influence of TAH , TVH and LTH on sexual function in women of different ages was compared.Results There was no significant difference in fertility and ovarian function in the same age group of different operation method groups.Gravidity, parity and self rating of ovarian function in age group of 48 and over were significantly higher than those in age group under 48 in TAH, TVH and LTH groups (t value was 13.22, 14.57 and 22.53, respectively, all P<0.05).There was no significant difference in sexual function score in age group under 48 among TAH group, TVH group and LTH group (P>0.05).In age group of 48 and over, FSFI score in TAH group was significantly lower than that in TVH group and LTH group ( t value was 14.39 and 18.21, respectively, both P<0.05), but there was no significant difference between TVH group and LTH group (P>0.05).In three groups, postoperative sexual function score of patients under 48 was significantly higher than that of patients aged 48 or over in the same group ( t value was 9.76, 10.21 and 13.25, respectively, all P<0.05).Conclusion No significant influence of TAH, TVH and LTH on sexual function is found in patients under 48, while TAH may reduce sexual function of patients aged 48 or over.%目的 探讨开腹全子宫切除术(TAH)、阴式全子宫切除术(TVH)及经腹腔镜全子宫切除术(LTH)对女性性功能的影响.方法 将2013年12月至2015年12月于江苏省淮安市肿瘤医院行子宫全切除术的60例子宫肌瘤患者纳入研究,按照不同的手术方式分为TAH组(23例)、TVH组(23例)和LTH组(14例).根据年龄是否≥48岁,每组患者分为两个亚组.术后随访1年,采用女性性功能量表(FSFI)检测患者的性功能评分,比较TAH、TVH及LTH对不同年龄段女性性功能的影响.结果不同手术组中同一年龄段的生育和卵巢功能比较无明显差异,但TAH组、TVH组、LTH组中≥48岁组的孕次、产次及卵巢功能自我评分均明显高于同组<48岁组患者(t值分别为13.22、14.57、22.53,均P<0.05).在<48岁的年龄段中,TAH组、TVH组和LTH组的性功能评分组间比较均无明显差异(P>0.05);在≥48岁的年龄段中,TAH组的FSFI总分明显低于TVH组及LTH组(t值分别为14.39、18.21,均P<0.05),TVH组与LTH组比较无明显差异(P>0.05).3组患者中,与≥48岁患者相比,同组<48岁患者的术后性功能评分明显较高(t值分别为9.76、10.21、13.25,均P<0.05).结论 TAH、TVH和LTH对年龄<48岁患者的性功能影响无明显差异;而TAH可能降低年龄≥48岁患者的性功能.