妇科腹腔镜手术对女性抗谬勒氏管激素水平影响的研究

Effect of laparoscopic surgical procedures on serum anti-Mullerian hormone level

目的探究妇科常见的腹腔镜手术(子宫切除手术、卵巢囊肿剥除手术、输卵管切除术)对女性抗缪勒氏管激素(anti-Mullerian hormone,AMH)水平的影响,以更好了解术后卵巢储备功能。方法选择2019年11月至2022年2月在本院妇产科诊治的妇科疾病患者162例,其中子宫组56例,卵巢组52例,输卵管组54例;比较3类常见妇科手术对患者术前、术后1、3、6个月的AMH水平。在此基础上,再将同一类型、不同手术方式的AMH的变化进行对比。结果术前三组AMH无差异,在术后1月,卵巢组及子宫组血清AMH较同期输卵管组明显下降(P=0.04)。在术后3、6个月,3组血清AMH值无差异(P=0.1,P=0.33),△AMH也在逐渐下降。同一类型,不同手术方式对AMH水平影响的结果显示:与子宫次全切相比,子宫全切患者在术后1、3、6个月血清AMH水平较术前下降更明显(P=0.016,P=0.021,P=0.021);双侧卵巢切除AMH下降程度明显高于单侧卵巢切除。结论三类妇科常见腹腔镜手术对卵巢功能均有不利影响;其中卵巢组最为明显,其次是子宫切除术,输卵管切除术影响最小;且子宫全切较次全切,双侧卵巢切除较单侧卵巢切除对术后卵巢储备下降的影响更为显著,双侧输卵管切除术在术后1个月影响较大,单侧卵巢切除术无影响。

Objective To investigate the effect of 3 laparoscopic surgical procedures(hysterectomy,oophorectomy and fallectomy)on anti-Mullerian hormone(AMH)level.MethodsA total of 162 women who were treated with laparoscopic surgical procedures(56 cases of hysterectomy,52 cases of oophorectomy and 54 cases of fallectomy)in our department from November 2019 to February 2021 were enrolled in this study.The AMH level of each patient was compared preoperatively,and 1,3 and 6 months postoperatively.The changes in AMH for the same type,different surgical procedures,were also compared.Results No statistical difference was observed in preoperative serum AMH level among the 3 groups of patients(P>0.05),and the level was significantly decreased in the ovarian and hysterectomy groups than the fallopian tube group in 1 month postoperatively(P=0.04).At 3 and 6 months postoperatively,there was no difference in serum AMH level in the 3 groups(P=0.1,P=0.33),and△AMH level was decreased gradually.For the same type,different surgical procedures,when compared with subtotal hysterectomy,serum AMH level was decreased more significantly in patients with total hysterectomy at 1,3 and 6 months postoperatively than preoperative level(P=0.016,P=0.021,P=0.021),and the decrease in AMH was more obviously in bilateral than in unilateral oophorectomy.Conclusion All these 3 types of common laparoscopic gynecological surgeries affect ovarian function,with ovarian surgery most significant,followed by hysterectomy and then salpingo-oophorectomy.Total uterine resection has more obvious effect on postoperative decline in ovarian reserve than sub-total uterine resection,and bilateral salpingo-oophorectomy than unilateral salpingo-oophorectomy,especially in 1 month postoperatively,while no such effect is observed in unilateral salpingo-oophorectomy.