促性腺激素释放激素激动剂（GnRHa）对腹腔镜早期宫颈癌术后卵巢功能的保护作用

唐飞 徐娟 邵柳娟 韦伟

[摘要] 目的 觀察促性腺激素释放激素（gonadotropin-releasing hormone agonists，GnRHa）对早期宫颈癌患者腹腔镜手术后的卵巢功能的保护作用。 方法 将金华市中心医院2016年12月～2018年5月收治的60例早期宫颈癌腹腔镜手术患者，随机分为术后使用GnRHa组和未使用GnRHa组，各30例。比较两组患者治疗前后性激素水平、卵巢体积和卵泡监测情况。 结果 手术后1个月两组卵泡刺激素（Follitropin beta，FSH）、黄体生成素（Lutropin alfa，LH）均升高，两组之间的差异无统计学意义（P>0.05），抗缪勒氏管激素（Antimullerian hormone，AMH）均下降，但未使用GnRHa组更明显（P<0.05）。术后6个月未使用GnRHa组FSH、LH水平显著低于未使用GnRHa组，AMH水平显著高于未使用GnRHa组（P<0.05）;术后1个月两组卵巢体积及窦卵泡数目均有所减少，但两组之间的差异无统计学意义（P>0.05）;术后3、6个月未使用GnRHa组较使用GnRHa组卵巢体积及窦卵泡数明显减少，差异均有统计学意义（P<0.05）。 结论 腹腔镜宫颈癌根治卵巢移位手术可致卵巢功能损害，AMH联合窦卵泡计数（AFC）检测能较好地评估卵巢的储备作用，GnRHa对早期宫颈癌患者卵巢移位术后的卵巢功能具有一定的保护作用。

[关键词] 促性腺激素释放激素激动剂;腹腔镜;卵巢功能;宫颈癌

[中图分类号] R713.2          [文献标识码] B          [文章编号] 1673-9701（2020）18-0078-04

Protective effect of gonadotropin-releasing hormone agonists （GnRHa） on ovarian function after laparoscopic surgery for early cervical carcinoma

TANG Fei1 XU Juan1 SHAO Liujuan1 WEI Wei2

1.Department of Gynecology， Jinhua Municipal Central Hospital in Zhejiang Province， Jinhua   321000， China; 2.Department of Obstetrics and Gynecology， Sir Run Run Shaw Hospital， Zhejiang University School of Medicine， Hangzhou 310016， China

[Abstract] Objective To observe the protective effect of gonadotropin-releasing hormone agonists（GnRHa） on the ovarian function of the patients with early cervical carcinoma after laparoscopic surgery（LS）. Methods Sixty patients with early cervical carcinoma undergoing laparoscopic surgery admitted to Jinhua Municipal Central Hospital from December 2016 to May 2018 were randomly divided into two groups，group with GnRHa and group without GnRHa with thirty patients in each group. Those registered GnRHa after operation were taken as the treatment group， while those who were not registered GnRHa were taken as the control group. Sex hormone levels， ovarian volume and results of follicular monitoring before and after treatment were compared between the two groups. Results 1 m after operation， the follicle-stimulating hormone （FSH） and luteinizing hormone（LH） increased in both groups， and there was no statistically significant difference between the two groups（P>0.05）; the anti-Mullerian hormone （AMH） decreased in both groups， but the decrease was more obvious in the group not registered GnRHa（P<0.05）. 6 m after operation， the FSH and LH levels in the group registered GnRHa were significantly lower than those in the group not registered GnRHa，and the AMH level was significantly higher than that in the group not registered GnRHa（P<0.05）. 1 m after operation， the ovarian volume and the antral follicle count （AFC） in the two groups decreased，but the differences between the two groups were not statistically significant（P>0.05）.3 or 6 m after operation， the ovarian volume and the AFC in the group not registered GnRHa were significantly reduced when compared with the group registered GnRHa， and the differences were statistically significant（P<0.05）. Conclusion Laparoscopic radical ovarian transposition for cervical carcinoma might incur damage to ovarian function. AMH combined with AFC detection can better evaluate ovarian reserve function. GnRHa has certain protective effect on the ovarian function after ovarian transposition for the patients with early cervical carcinoma.

[Key words] Gonadotropin-releasing hormone agonists （GnRHa）; Laparoscopy; Ovarian function; Cervical carcinoma

目前，宫颈癌的发病呈现出年轻化趋势，50%以上的患者发病时尚未绝经[1]，手术是早期宫颈癌主要治疗措施之一，但手术治疗对卵巢功能有不同程度的损伤，术后患者卵巢早衰发生率上升[2]。而卵巢是女性的重要内分泌器官，卵巢功能对维持女性的生理心理学健康具有至关重要的作用，因此保留宫颈癌患者术后生育及内分泌功能、改善其术后生活质量尤为重要[3]。如何在治疗肿瘤的同时保存妇女的卵巢功能，如何减少手术对卵巢功能的影响一直是妇科肿瘤研究的热点，对此本研究通过临床随机实验来进一步观察促性腺激素释放激素激动剂（GnRHa）对早期宫颈癌患者术后卵巢功能的保护功能作用，现报道如下。

1 资料与方法

1.1 一般资料