腹腔镜下不同手术方式治疗输卵管积水对卵巢储备功能的影响

Research on different laparoscopic procedures for hydrosalpinx on ovarian reserve

目的比较腹腔镜下双输卵管近端阻断远端造口术和双输卵管切除术对卵巢储备功能的影响。方法选择因双侧输卵管积水行腹腔镜下双侧输卵管近端阻断远端造口术的不孕患者55例为研究组,以同期相同原因行腹腔镜下双侧输卵管切除术的不孕患者30例为对照组,比较两组患者手术前、术后第一个和第三个月经周期基础内分泌变化以及超促排卵周期中促性腺激素(Gn)用量和时间及体外受精-胚胎移植(IVF-ET)结局。结果研究组术后第一个月经周期、第三个月经周期血促卵泡生成素(FSH)和雌二醇(E2)水平分别与术前比较,差异均无统计学意义(t分别=-1.01、-1.66、1.02、-0.28,P均>0.05);对照组术后第一个月经周期、第三个月经周期FSH和E2水平分别与术前比较,差异均无统计学意义(t分别=-0.09、-0.67、-0.50、0.20,P均>0.05)。两组间术前、术后第一个、第三个月经周期FSH和E2比较,差异均无统计学意义(t分别=0.73、0.28、0.82、-0.84、-2.12、-0.72,P均>0.05);两组Gn用量、用药时间、获卵数比较,差异均无统计学意义(t分别=0.37、0.03、1.10、0.21,P均>0.05);两组间受精率、卵裂率、优质卵泡率、种植率、临床妊娠率和早期流产率比较,差异均无统计学意义(χ2分别=0.01、0.46、0.14、0.08、3.51、0.15,P均>0.05),两组间优质胚胎数和移植胚胎数比较,差异均无统计学意义(t分别=0.48、1.11,P均>0.05)。结论腹腔镜下双输卵管近端阻断远端造口术和双输卵管切除术后卵巢储备功能及IVF-ET妊娠结局无明显差异,两者均可作为输卵管积水患者行IVF-ET前手术预处理的主要选择方式。

Objective To evaluate effects of different laparoscopic procedures for hydrosalpinx on ovarian reserve. Methods Group A （n=55） were treated with laparoscopic proximal tubal blocking and distal tubal salpingostomy, and group B （n=30） were treated with laparoscopie bilateral salpingectomy for hydrosalpinx. The basal level of estradiol （E2） and follicle stimulating hormone（FSI4 ） before and first, third menstrual cycle after the operation were observed. The ovarian responses to superovulation and the clinical outcome of IVF-ET were evaluated. Results There were no differences be- tween preoperative and postoperative first, third menstrual cycle about basal FSH, E2 in the study group（t=-1.01,-1.66,1.02, -0.28, P〉0.05 ）.And no differences between basal and postoperative first, third menstrual cycle about FSH, E2 in the control group was observed （t=-0.09, -0.67, -0.50, 0.20, P〉0.05 ）. There were no differences between 2 groups about ampules and days of gonadotropin（Gn） administration（t=0.37, 0.03, 1.10, 0.21, P〉O.05）,the number of ooeytes retrieved, fertilization rates, cleavage rates,good--embryo ratio,implantation rates,clinical pregnancy rates and abortion rates （χ2/t=0.01, 0.46, 0.48, 0.14, 1.11, 0.08, 3.51, 0.15,P〉0.05）. Conclusions There were no obvious effect on the baseline endocrine and outcome of IVF-ET either laparoscopie proximal tubal blocking plus distal tubal salpingostomy or laparoseopie bilateral salpingectomy. Both of the procedures can be considered for the treatment of hydrosalpinx prior to IVF-ET.