腹腔镜下输卵管手术方式对卵巢储备功能的影响分析

Analysis of the effect of different laparoscopic tubal operations on ovarian reserve function

目的分析腹腔镜下输卵管不同手术方式对输卵管积水患者卵巢储备功能的影响。方法 78例输卵管积水患者,采用随机数字表法分为A、B、C组,各26例。A组给予腹腔镜下输卵管切除术,B组给予输卵管造口术,C组给予输卵管近端离断远端造口术。比较并记录三组患者术前及术后1、3个月的血清抗苗勒氏管激素(AMH)、卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、窦卵泡数(AFC)的变化。结果 A组患者术后1个月的FSH、LH、E2、AMH、AFC分别为(6.23±1.30)U/L、(7.36±1.40)ng/ml、(113.2±29.5)ng/L、(4.00±1.00)μg/L、(6.13±1.30)个,3个月的FSH、LH、E2、AMH、AFC分别为(6.18±1.60)U/L、(7.28±1.30)ng/ml、(118.2±31.2)ng/L、(4.02±1.01)μg/L、(6.09±1.50)个;B组患者术后1个月的FSH、LH、E2、AMH、AFC分别为(4.02±1.10)U/L、(6.12±2.30)ng/ml、(142.3±25.6)ng/L、(4.86±1.80)μg/L、(7.69±2.30)个,3个月的FSH、LH、E2、AMH、AFC分别为(3.95±0.70)U/L、(6.05±1.80)ng/ml、(140.3±26.3)ng/L、(4.82±1.40)μg/L、(7.45±2.10)个;C组患者术后1个月的FSH、LH、E2、AMH、AFC分别为(4.12±1.30)U/L、(6.11±1.50)ng/ml、(136.3±4.2)ng/L、(5.13±1.20)μg/L、(7.54±1.60)个;3个月的FSH、LH、E2、AMH、AFC分别为(4.09±0.90)U/L、(6.16±1.00)ng/ml、(134.1±3.9)ng/L、(5.01±0.70)μg/L、(7.21±1.50)个;A组患者术后1、3个月FSH、LH明显高于B、C组,E2、AMH、AFC明显低于B、C组,差异有统计学意义(P<0.05);B、C组AMH、FSH、LH、E2、AFC比较差异无统计学意义(P>0.05)。结论对输卵管积水患者给予腹腔镜下输卵管切除术会影响患者卵巢储备功能,影响患者生育功能,根据患者身体情况,应尽可能采用保守性手术治疗,避免手术造成的负性影响,保护卵巢储备功能。

Objective To analyze the effect of different laparoscopic tubal operations on ovarian reservefunction of hydrosalpinx patients. Methods A total of 78 hydrosalpinx patients were divided by random number table method into group A, group B and group C, with 26 cases in each group. Group A received laparoscopic tubal resection, group B received tubal ostomy and group C received tubal proximal detachment distal stoma. Comparison and record were made on changes of serum anti Mullerian hormone（AMH）, follicle stimulating hormone（FSH）, luteinizing hormone（LH）, estradiol（E2） and antral follicle count（AFC） in preoperation and postoperative 1 and 3 months between two groups. Results Group A had FSH, LH, E2, AMH and AFC in postoperative 1 month respectively as（6.23±1.30） U/L,（7.36±1.40） ng/ml,（113.2±29.5） ng/L,（4.00±1.00） μg/L,（6.13±1.30） pieces, and（6.18±1.60） U/L,（7.28±1.30） ng/ml,（118.2±31.2） ng/L,（4.02±1.01） μg/L,（6.09±1.50） pieces in postoperative 3 months. Group B had FSH, LH, E2, AMH and AFC in postoperative 1 month respectively as（4.02±1.10） U/L,（6.12±2.30） ng/ml,（142.3±25.6） ng/L,（4.86±1.80） μg/L,（7.69±2.30） pieces, and（3.95±0.70） U/L,（6.05±1.80） ng/ml,（140.3±26.3） ng/L,（4.82±1.40） μg/L and（7.45±2.10） pieces in postoperative 3 months. Group C had FSH, LH, E2, AMH and AFC in postoperative 1 month respectively as（4.12±1.30） U/L,（6.11±1.50） ng/ml,（136.3±4.2） ng/L,（5.13±1.20） μg/L,（7.54±1.60） pieces, and（4.09±0.90） U/L,（6.16±1.00） ng/ml,（134.1±3.9） ng/L,（5.01±0.70） μg/L,（7.21±1.50） pieces in postoperative 3 months. Group A had obviously higher FSH and LH in postoperative 1 and 3 months than group B and group C, and obviously lower E2, AMH, AFC than group B and group C. Their difference was statistically significant（P〈0.05）. Group B and group C had no statistically significant difference in AMH, FSH, LH, E2, AFC（P〉0.05）. Conclusion For hydrosalpinx patients, laparoscopic tubal resection will affect the ovarian reserve function and the reproductive function of patients. Conservative surgical treatment should be chosen according to the patient’s condition, so as to avoid the negative effects caused by the operation and protect the ovarian reserve function.