腹腔镜下输卵管积水不同手术方式对卵巢储备功能的影响

Effects of laparoscopic management for hydrosalpinx on ovarian reserve

目的探讨腹腔镜下保留及切除输卵管后对卵巢储备功能的影响。方法将2010年5月至2012年5月,因输卵管积水在本院行腹腔镜手术处理的88例患者,按手术方式分为三组。A组(n=30)保留双侧输卵管,行输卵管近端结扎远端造口术,B组(n=28)行单侧输卵管切除及对侧输卵管近端结扎及伞端造口术,C组(n=30)行双侧输卵管切除术。观察患者术后1个月、3个月的血清雌二醇(E2)、卵泡刺激素(FSH)、基础抑制素(INH)水平的变化,以及术后月经恢复情况。结果三组患者手术前、后血清E2、INH水平及窦状卵泡数比较,差异均无统计学意义(P>0.05)。三组患者组间比较差异亦无统计学意义(P>0.05)。A、B组患者手术前、后血清FSH差异无统计学意义。C组术后第一次月经周期FSH升高(P<0.05),但术后第三次月经周期降为正常,与术前比较差异无统计学意义(P>0.05)。结论腹腔镜下输卵管积水不同的手术方式对卵巢储备功能无明显影响。

Objective To evaluate the effects of different laparoscopic procedures for hydrosalpinx on ovari- an reserve. Methods Eighty-eight infertile women with hydrosalpinx undergoing laparoseopie operation before in vi- tro fertilization-embryo transfer （IVF-ET） from May 2010 to May 2012 were divided into three groups, according to the different laparoscopic managements. Group A （n=30） were treated with proximal tubal blocking and distal tubal salpingostomy. Group B （n=28） were treated with one-sided salpingeetomy, one-sided proximal tubal blocking and distal tubal salpingostomy. Group C （n=30） were treated with bilateral salpingectomy. The basal level of estradiol （E2）, follicle stimulating hormone （FSH）, inhibin （INH） and the count of antral follicle （Fo） were observed before the operation and at the first, third menstrual cycle after the operation. And the menstruation recovery was evaluated. Results There was no statistically significant difference before and after the operation about the level of E2, INH and fo among the three groups （P〉0.05）, and no statistically significant difference between basal and post-operative about FSH in the group A and B was observed. In group C, the level of FSH at the first menstrual cycle after the opera- tion had significant different compared with pre-operation （P〈0.05）, but there was no significant difference at the third menstrual cycle （P〉 0.05）. Conclusion There seems to be weak effect of different laparoscopic procedures for hydro- salpinx on ovarian reserve. Laparosopic salpingectomy, laparoscopic proximal tubal ligament, and distal tubal salpin- gostomy may be considered as suitable treatment of hydrosalpinx prior to in vitro fertilization-embryo transfer.