腹腔镜下双侧输卵管结扎术、输卵管切除术与近端灼断术对不孕患者卵巢储备功能及术后妊娠率影响

Influence of laparoscopic bilateral tubal ligation,salpingectomy,and proximal cauterization of tubal ligation for treating patients on their ovarian reserve and pregnancy rate

目的:比较腹腔镜下双侧输卵管结扎术、输卵管切除术与近端灼断术对输卵管性不孕患者卵巢储备及术后妊娠率的影响.方法:回顾性分析2018年7月-2020年6月在本院诊治的因输卵管因素导致的不孕患者142例临床资料,均行腹腔镜下手术,按照输卵管治疗术式不同分为结扎组48例、切除组45例、近端灼断组49例.比较各组卵巢储备功能及术后1年妊娠成功率.结果:术后1、3、12个月结扎组、灼断组的卵巢截面积、卵巢窦卵泡数(AFC)、舒张末期血流速度(EDV)、收缩期峰值血流速度(PSV)均高于切除组,阻力指数(RI)低于切除组(均P<0.05),但结扎组与切除组上述指标无差异(P>0.05).术后1年辅助生殖妊娠成功率结扎组(52.1%)、切除组(53.3%)、灼断组妊(51.0%)无差异(P>0.05).结论:腹腔镜下双侧输卵管结扎术、输卵管切除术、近端灼断术治疗因输卵管因素导致的不孕,术后1年妊娠成功率相当,但切除方式对患者卵巢储备功能影响较大.

Objective: To compare the influence of laparoscopic bilateral tubal ligation, salpingectomy, and proximal cauterization of tubal ligation for treating patients on their ovarian reserve and pregnancy rate after operation. Methods: The clinical data of 142 patients with infertility caused by fallopian tube factors who had accepted the laparoscopic operation from July 2018 to June 2020 were analyzed retrospectively. According to the different treatment methods, these patients were divided into 48 cases with bilateral tubal ligation in group A, 45 cases with salpingectomy in group B, and 49 cases with proximal cauterization of tubal ligation in the group C. The ovarian reserve function and the pregnancy success rate within 1 year after operation of the patients were compared among the three groups. Results: The cross-sectional area of ovary, the antral follicle count(AFC), the end-diastolic flow velocity(EDV), and the peak systolic flow velocity(PSV) of the patients in group A and group B in the 1 st, 3 rd, and 12 th month after operation were significantly higher than those of the patients in group C, and the resistance index(RI) value of the patients in group A and group B was significantly lower than that of the patients in group C(all P<0.05), but which all of the patients had no significant differences between group A and group B(P>0.05). The success rate of pregnancy within 1 year after operation of the patients(52.1%) in group A had no significant difference of that(53.3%) of the patients in group C and that(51.0%) of the patients in group B(P>0.05). Conclusion: Laparoscopic bilateral tubal ligation, salpingectomy, and proximal cauterization of tubal ligation for treating the infertility patients caused by fallopian tube factors have similar success pregnancy rate within 1 year after operation. However, laparoscopic salpingectomy has a greater impact on the ovarian reserve of the patients.