AMH在妇科腹腔镜手术前后卵巢功能中的评估价值

Evaluation of AMH in Ovarian Function Before and After Laparoscopic Gynecological Surgery

【目的】探讨抗苗勒管激素（anti—mullerian hormone，AMH）在妇科腹腔镜手术前后卵巢功能中的评估价值。【方法】选择2016年1月至2016年12月本院妇产科诊治的妇科疾病患者370例，其中卵巢组80例，子宫肌瘤组90例，输卵管组200例。比较各种术式患者术前、术后6周及术后6个月的AMH水平。【结果】卵巢巧克力囊肿患者、非巧克力囊肿患者术后6周及6个月血清AMH水平较术前均显著下降（P〈0．05），且术后6个月血清AMH水平显著低于术后6周（P〈0．05），但卵巢巧克力囊肿患者AMH水平比非巧克力囊肿患者下降更为显著（P〈0．05）。次全子宫切除术患者、子宫肌瘤剔除术患者术前血清AMH比较差异均无统计学意义（P〉0．05）；两组术后6周、6个月的血清AMH水平较术前降低（P〈0．05），且两组术后6个月血清AMH水平均显著低于术后6周（P〈0．05），次全子宫切除术患者血清AMH水平低于同期子宫肌瘤剔除术患者。单侧输卵管切除组和单侧输卵管切除＋对侧输卵管结扎组术前血清AMH水平比较差异无统计学意义（P〉0．05）；单侧输卵管切除组术后6个月血清AMH水平均显著低于术前（P〈0．05）；单侧输卵管切除组和单侧输卵管切除＋对侧输卵管结扎组术前后各时点血清AMH水平比较差异无统计学意义（P〉0．05）。【结论】术后6个月，腹腔镜下卵巢囊肿剥除术对卵巢储备功能有不利影响；且巧克力卵巢囊肿较非巧克力卵巢囊肿，术后卵巢储备下降更明显；腹腔镜下次全子宫切除术对卵巢储备有不利影响，子宫肌瘤剔除术影响不大。腹腔镜下单侧输卵管切除组和单侧输卵管切除＋对侧输卵管结扎组对卵巢储备功能均有不利影响，需要根据患者病情和要求采取合适的手术方式。

[Objective]To evaluate the value of anti-mullerian hormone （AMH） in the evaluation of ovarian function before and after laparoscopic gynecologic surgery. [Methods]From January 2016 to December 2016, 370 cases of gynecological diseases diagnosed and treated in gynecology and obstetrics department in our hospital were selected.There were 80 cases in ovary group, 90 cases in hysteromyoma group and 200 cases in fallopian tube group. The levels of AMH were compared at the time before operation, 6 weeks and 6 months after operation.[Results] The serum AMH levels in pa tients with ovarian chocolate cysts and those with non-chocolate cysts at 6 weeks and 6 months after operation were significantly lower than those before operation （P〈0.05）. The level of serum AMH 6 of months after operation was signifi- cantly lower than that of 6 weeks after the operation （ P 〈0.05）.However, the level of AMH in patients with ovarian chocolate cysts was significantly lower than that in patients with non-chocolate cysts （ P 〈0.05）. There was no signifi- cant difference in serum AMH between subtotal hysterectomy patients and hysteromyomectomy patients （P 〈0.05）. 6 weeks and 6 months after operation, the serum AMH level in both groups was significantly lower than that before operation （ P 〈 0.05） ,and the level of serum AMH at 6 months after operation in both groups was significantly lower than that at 6 weeks after operation （ P 〈0.05）. The serum AMH level of subtotal hysterectomy patients was lower than that of hysteromyomeetomy patients in the same period. There was no significant difference in serum AMH level between the unilateral salpingotomy group and the unilateral salpingotomy group ＋ the contralateral salpingotomy group （ P 〈0.05）. The serum AMH level in unilateral salpingotomy group at months after operation was significantly lower than that of preoperation （ P 〈 0.05）. There was no significant difference in serum AMH levels between the unilateral salpingotomy group and the unilateral salpingotomy group ^- the contralateral salpingotomy group （P 〉 0. 05 ）. [Conclusion] Six months after operation, laparoscopie excision of ovarian cysts had adverse effects on ovarian reserve function, and the o-varian reserve of chocolate ovarian cysts decreased more obviously than that of non chocolate ovarian cysts. Laparoscopic subtotal hysterectomy has a negative effect on ovarian reserve, while uterine myomectomy has little effect. The unilateral salpingotomy group and the unilateral salpingotomy group ＋ the contralateral salpingotomy group under laparoscopy have adverse effects on ovarian reserve function.Appropriate surgical methods should be adopted according to the patient＇s condition and requirement.