不同腹腔镜手术方式治疗输卵管积水对卵巢储备功能及IVF-ET妊娠结局的影响

Effect of different laparoscopic methods on IVF-ET reproductive outcomes and ovarian reserve function in the treatment of hydrosalpinx

目的探讨腹腔镜处理双侧输卵管积水后对卵巢储备功能及IVF-ET结局的影响。方法回顾性分析2015年1月至2017年1月84例于中国医科大学附属盛京医院就诊的双侧输卵管积水的患者资料,A组为行腹腔镜下双侧输卵管切除术21例,B组为行腹腔镜下双侧输卵管近端结扎远端造口术63例;B1组于输卵管间质部行腹腔镜下双侧输卵管结扎术+远端造口术28例,B2组于输卵管峡部行腹腔镜下双侧输卵管结扎术+远端造口术35例。结果 A、B组抗米勒管激素(AMH)、卵泡刺激素(FSH)、雌二醇(E2)、FSH/黄体生成素(LH)比较,差异无统计学意义(P>0.05),但A组LH高于B组[(5.44±2.93)U/L,(3.20±1.40)U/L],差异有统计学意义(P<0.05);A、B两组妊娠结局比较,差异无统计学意义(P>0.05);B1、B2两组妊娠结局比较,差异无统计学意义(P>0.05)。结论与输卵管结扎术相比,输卵管切除术可一定程度上降低卵巢储备功能;不同部位输卵管结扎后IVF-ET结局无明显差异。

Objective To investigate the effect of laparoscopic treatment for bilateral hydrosalpinx on ovarian reserve function and IVF-ET(in vitro fertilization and embryo transfer,IVF-ET)outcomes.Methods A retrospective analysis was performed in 84 patients with bilateral hydrosalpinx admitted to Shengjing Hospital Affiliated to China Medical University from January 2015 to January 2017.Group A underwent bilateral salpingectomy(21 cases)and group B underwent laparoscopic bilateral tubal proximal ligation distal ostomy(63 cases);group B1 included cases of tubal interstitial tubal ligation and distal ostomy(28 cases)and group B2 included cases of fallopian tube tubal ligation and distal ostomy(35 tubal ligation cases).Results There was no significant difference in anti-Mullerian hormone(AMH),follicle stimulating hormone(FSH),estradiol(E2),or FSH/luteinizing hormone(LH)levels between groups A and B(P>0.05),but the LH level of group A was higher than that of group B[(5.44±2.93)U/L vs.(3.20±1.40)U/L];this difference was statistically significant(P<0.05).There was no significant difference in reproductive outcomes between the two groups(P>0.05).There was no significant difference in reproductive outcomes between groups B1 and B2(P>0.05).Conclusion Compared with tubal ligation,salpingectomy can reduce ovarian reserve function to a certain extent;there is no significant difference in IVF-ET outcomes after tubal ligation at different locations.