CERRAHİ METODUN TÜRÜNE GÖRE HİSTEREKTOMİNİN AMELİYAT SONRASI ERKEN DÖNEMDE OVER REZERVİNE ETKİSİ

Year 2023, Volume: 86 Issue: 2, 123 - 129, 30.03.2023

Özden Öztürk , Tayfur Çift , Süleyman Serkan Karaşin

https://doi.org/10.26650/IUITFD.1210689

Abstract

Amaç: Bu çalışmada yapılan histerektomi tipine göre over rezervinin ne kadar etkilendiğini tahmin etmeyi amaçladık. Gereç ve yöntem: Çalışmamız tek merkezli prospektif kesitsel bir çalışmadır. Temmuz 2021 ile Mart 2022 arasında benign histerektomi yapılan 82 hastayı dahil ettik. Abdominal histerektomi (n=54) ve laparoskopik (L/S) histerektomi (n=28) olmak üzere iki grup vardı. Histerektomi öncesi ve sonrası transvajinal ultrasonografi ve hormon durumu değerlendirildi. Ameliyat öncesi anti-Müllerian hormon (AMH) değeri 0,01 ng/dl’nin üzerinde ve folikül uyarıcı hormon (FSH) değeri 15 IU/L’nin altında olan hastalar çalışmaya alındı. Bulgular: Gruplar arasında yaş, parite, süre ve kanama açısından anlamlı fark vardı. Abdominal ve laparoskopik histerektomiler arasında AMH değerindeki azalma yüzdesi açısından anlamlı bir fark yoktu. Over hacmindeki azalma miktarı ve antral folikül sayısı (AFS) parametreleri açısından karşılaştırmada fark yoktu. Serum estradiol değerlerinin analizinde 33 hastada artış, 49 hastada düşüş gözlendi. Artanların %63,7’si, azalanların ise %67,3’ü abdominal histerektomi geçirenlerdi. Estradiol değerleri arasındaki fark istatistiksel olarak anlamlı değildi. FSH parametrelerindeki artış miktarı ve hızı açısından karşılaştırmalı analizde iki grup arasında fark vardı (p=0,03). Sonuç: Her iki grupta da ameliyat öncesi ve sonrası over rezervinde azalma gözlendi. Aralarında yapılan analizlerde anlamlı bir fark gözlenmedi. FSH düzeylerindeki artış L/S lehine daha anlamlıydı. Elektrotermal enerji kullanımına bağlı olarak over foliküllerinde inhibin-B düzeylerinin araştırılması da dahil olmak üzere, karın cerrahisine kıyasla L/S histerektominin yumurtalık rezervi üzerindeki etkisini araştırmak için prospektif büyük ölçekli çalışmalara ihtiyaç vardır.

Keywords

Histerektomi, yumurtalık rezervi, anti-mullerian hormon, folikül uyarıcı hormon, estradiol

THE EFFECT ON OVARIAN RESERVE IN THE EARLY POSTOPERATIVE PERIOD IN HYSTERECTOMY ACCORDING TO THE TYPE OF SURGERY

Abstract

Objective: The aim of this study was to estimate the possible differential levels of influence of the applied hysterectomy type on ovarian reserve. Materials and Methods: Our study is a single-center prospective cross-sectional study. We included 82 patients who underwent benign hysterectomies between July 2021 and March 2022. There were two groups, abdominal hysterectomy (n=54) and laparoscopic (L/S) hysterectomy (n=28). Transvaginal ultrasonography and hormone status were evaluated before and after the hysterectomy. Patients with a preoperative anti-Mullerian hormone (AMH) value greater than 0.01 ng/dl and a follicle stimulating hormone (FSH) value less than 15 IU/L were included in the study. Results: There was a significant difference between the groups regarding age, parity, duration, and bleeding. There was no significant difference in the percent decrease in AMH value between abdominal and laparoscopic hysterectomies. There was no difference in the comparison regarding the amount of decrease in ovarian volume and antral follicle count (AFS) parameters. In the analysis of serum estradiol values, an increase in 33 patients and a decrease in 49 patients were observed. While serum estradiol values decreased in 33 of 54 patients who underwent abdominal hysterectomy, this rate was 67.3% among patients with decreased estradiol. The difference in estradiol values was not statistically significant. There was a difference between the two groups in the comparative analysis regarding the amount and rate of increase in FSH parameters (p=0.03). Conclusion: In both groups a decrease in ovarian reserve before and after surgery was observed. No significant difference was observed in the analyses performed between them. The increase in FSH levels was more significantly in favor of L/S. Prospective large-scale studies are needed to investigate the effect of L/S hysterectomy on ovarian reserve compared to abdominal surgery, including investigating inhibin-B levels in ovarian follicles due to electrothermal energy use.

Keywords

Hysterectomy, Ovarian Reserve, Anti-Mullerian Hormone, Follicle Stimulating Hormone, Estradiol

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