腹腔镜不同方式输卵管切除对输卵管妊娠患者抗苗勒管激素的影响

Influence on anti-mullerian hormone by different operation methods under laparoscope in treatment of salpingocyesis

目的探讨输卵管妊娠患者腹腔镜不同方式输卵管切除对抗苗勒管激素(AMH)的影响。方法选择2015年1月~2017年1月我院确诊为初次患输卵管妊娠且输卵管无法保留的患者60例,随机分为三组,每组20例。Ⅰ组采取单极电钩以凝代切切除患侧输卵管;Ⅱ组用0号DEXON线2次套扎输卵管伞端至峡部近宫角部系膜部,切除输卵管;Ⅲ组采用双极电凝患侧输卵管系膜后切除患侧输卵管。采用放射免疫法检测三组术前及术后第1、3、6个月监测AMH及患侧窦卵泡数(AFC),通过数据统计分析、比较。观察不同方式切除异位妊娠输卵管对卵巢储备功能的影响。结果 (1)术前、术后三组AMH水平都在正常范围内;(2)Ⅰ、Ⅱ、Ⅲ组术前AMH及AFC差异无统计学意义(P>0.05)。(3)术后第1个月,Ⅰ、Ⅱ、Ⅲ组AMH及AFC的比较,其中Ⅱ组患者下降明显(P<0.05)。(4)术后各时间点三组AMH和AFC,术后第3、6个月经周期与术前比较,差异无统计学意义(P>0.05))。结论腹腔镜输卵管妊娠三种输卵管切除术可能对卵巢储备功能产生一定的近期影响,其中套扎线切除输卵管对卵巢储备功能近期影响稍大。

Objective To study the influence on anti-mullerian hormone（AMH） with different operation methods under laparoscope in treatment of salpingoeyesis.Methods A total of 60 patients with tubal pregnancy from January 2015 to January 2017 were randomly divided into three groups with 20 cases in each group.For GroupⅠ,the monopolar electrical hook was adopted to eliminate the side fallopian tube with coagulation.For group Ⅱ,the fallopian tube was ligated two times from the umbrella end to the cornual membrane near the isthmus using on DEXON thread before removing the fallopian tube.For group Ⅲ,the lateral fallopian tube was resected after the tubal mesangial membrane was bipolar electrocoagulated.The radio-immunity method was employed to monitor the level of AMH and antral follicle count（AFC） in the affected side in the preoperative and 1,3 and 6 months postoperative periods.Through statistical analysis and comparison,the impacts to the ovarian reserve function due to different operation methods of fallopian tubal resection were observed.Results（1）The levels of AMH were in normal range before and after the operation.（2）there was no significant difference（P〉0.05） between preoperative AMH and AFC within the group ofⅠ,Ⅱ and Ⅲ before the operation.（3）In the 1 month after surgery,AMH and AFC all declined in groupⅠ,Ⅱ and Ⅲ,while AMH and AFC in group Ⅱdecreased significantly the difference were statistically significant（P〈0.05）.（4）In each time point after surgery,AMH and AFC of three groups,after surgery 3,6 months with compared before surgery,was not statistically significant（P〉0.05）.Conclusion Three types of tubal resection of laparoscopic tube may have certain effects on the function of the ovary,with the ligation and resection method having a slightly greater impact on the ovarian reserve function.