腹腔镜下两种手术方式治疗异位妊娠对卵巢功能影响对比分析

Comparative analysis of the influence of two surgical modes under laparoscope on the ovarian function in the treatment of ectopic pregnancy

目的探讨腹腔镜下两种手术方式治疗异位妊娠对卵巢功能的影响。方法 72例异位妊娠患者,随机分为A组与B组,每组36例。两组患者均在腹腔镜下施行手术,A组患者行输卵管切除术,B组患者行输卵管切开取胚术。对比两组手术相关指标(手术时间、术中出血量及术后住院时间)及术前、术后雌二醇(E_2)、睾酮(T)、孕酮(P)、促黄体生成素(LH)及促卵泡刺激素(FSH)水平的变化情况;术后随访6个月,记录并比较两组患者的月经复潮时间与排卵恢复情况。结果两组手术时间、术中出血量及术后住院时间比较差异均无统计学意义(P>0.05)。术后A组LH、FSH均高于术前,E_2、T、P均低于术前,差异均具有统计学意义(P<0.05);B组术前术后的E_2、T、P、LH、FSH水平比较差异均无统计学意义(P>0.05)。A组患者月经复潮时间(34.44±6.26)d长于B组的(28.26±4.21)d,差异具有统计学意义(P<0.05);而两组排卵恢复率比较差异无统计学意义(P>0.05)。结论腹腔镜下行输卵管切除术治疗异位妊娠对卵巢功能存在一定负面影响,在条件允许下,建议施行输卵管切开取胚术或其他术式治疗。

Objective To investigate the influence of two surgical modes under laparoscope on the ovarian function in the treatment of ectopic pregnancy.Methods A total of 72 patients with ectopic pregnancy were randomly divided into group A and group B,36 cases in each group.Patients of the two groups all underwent surgery under laparoscope,group A underwent salpingectomy,group B underwent incisions of fallopian tube for taking out the embryoes.The operative related indicators(operative time,intraoperative blood loss and postoperative length of stay),changes of estradiol(E2),testosterone(T),progesterone(P),luteinizing hormone(LH)and follicle stimulating hormone(FSH)levels before and after surgery between the two groups were compared.Followed up for 6 months after surgery,the menstrual recovery time and ovulation recovery between the two groups were recorded and compared.Results There were no significant differences in the operative time,intraoperative blood loss and postoperative length of stay between the two groups(P>0.05).After surgery,the levels of LH and FSH in group A were significantly higher than those before surgery,the levels of E2,T and P were significantly lower than those before surgery,the differences were statistically significant(P<0.05).There were no significant differences in the levels of E2,T,P,LH and FSH before and after surgery in group B(P>0.05).The menstrual recovery time of group A was(34.44±6.26)d,which was significantly longer than(28.26±4.21)d of the group B,the difference was statistically significant(P<0.05).But there was no significant difference in ovulation recovery rate between the two groups(P>0.05).Conclusion The application of salpingectomy under laparoscope on the ovarian function in the treatment of ectopic pregnancy has a negative effect,under conditions permit,it is recommended to perform incisions of fallopian tube for taking out the embryoes or other surgical treatments.