不同术式治疗未破裂型输卵管妊娠的效果及对血清性激素、AMH水平和远期预后的影响

Clinical efficacy of different surgical methods in the treatment of unruptured tubal pregnancy and their impact on serum sex hormones,AMH levels,and long-term prognosis

目的探讨不同术式治疗未破裂型输卵管妊娠的效果及对患者血清性激素、抗缪勒管激素(AMH)水平和远期预后的影响。方法回顾性分析2019年1月至2021年1月渭南市妇幼保健院收治的106例未破裂型输卵管妊娠患者的临床资料,根据不同的手术治疗方式将患者分为观察组54例和对照组52例,观察组患者采用腹腔镜下输卵管开窗手术,对照组患者采用腹腔镜下输卵管切除术。比较两组患者的手术情况及住院时间,以及治疗前和出院时的性激素[卵泡刺激素(FSH)、雌二醇(E2)、促黄体生成素(LH)、AMH、孕酮(P)]水平,并比较两组患者术后并发症及术后1年的宫内妊娠率。结果观察组患者的手术时间、术中出血量分别为(21.98±4.21)min、(48.29±5.07)mL,明显短(少)于对照组的(32.10±3.75)min、(59.21±6.24)mL,差异均有统计学意义(P<0.05);出院时,两组患者的FSH、E2、AMH、P水平均降低,且观察组上述指标分别为(5.12±1.27)IU/L、(40.12±4.29)pg/mL、(3.10±0.72)ng/mL、(0.50±0.07)nmol/L,明显低于对照组的(6.41±1.38)IU/L、(43.17±5.11)pg/mL、(3.91±0.61)ng/mL、(0.56±0.09)nmol/L,而LH水平均升高,且观察组的LH为(7.69±1.78)IU/L,明显高于对照组的(6.31±1.20)IU/L,差异均有统计学意义(P<0.05);观察组患者术后并发症发生率为3.70%,明显低于对照组的17.31%,差异有统计学意义(P<0.05);术后随访1年,观察组患者的宫内妊娠率为77.78%,明显高于对照组的53.85%,差异有统计学意义(P<0.05)。结论腹腔镜下输卵管开窗术治疗未破裂型输卵管妊娠可降低出血量,减少对卵巢功能的影响,安全性高,术后宫内妊娠率高,具有临床应用价值。

Objective To explore the clinical efficacy of different surgical methods in the treatment of unruptured tubal pregnancy and their impact on serum levels of sex hormones,anti-Müllerian hormone(AMH),and long-term prognosis in patients.Methods The clinical data of 106 patients with unruptured tubal pregnancy admitted to Weinan Maternal and Child Health Hospital from January 2019 to January 2021 were retrospectively analyzed.According to different surgical treatment methods,the patients were divided into an observation group of 54 cases(using laparoscopic salpingostomy)and a control group of 52 cases(using laparoscopic salpingectomy).The surgical conditions and length of hospital stay were compared between the two groups.The levels of sex hormones[follicle stimulating hormone(FSH),estradiol(E2),luteinizing hormone(LH),AMH,and progesterone(P)]before treatment and at discharge were recorded,and the postoperative complications and intrauterine pregnancy rate within one year after surgery were compared between the two groups.Results The surgical time and intraoperative bleeding volume of the observation group were(21.98±4.21)min and(48.29±5.07)mL,which were significantly shorter(less)than(32.10±3.75)min and(59.21±6.24)mL in the control group(P<0.05).At discharge,the FSH,E2,AMH,and P levels in both groups decreased,and the above indicators in the observation group were(5.12±1.27)IU/L,(40.12±4.29)pg/mL,(3.10±0.72)ng/mL,and(0.50±0.07)nmol/L,which were significantly lower than(6.41±1.38)IU/L,(43.17±5.11)pg/mL,(3.91±0.61)ng/mL,and(0.56±0.09)nmol/L in the control group;the LH levels in the two groups were all elevated,and the LH level in the observation group was(7.69±1.78)IU/L,which was significantly higher than(6.31±1.20)IU/L of the control group;the differences were statistically significant(P<0.05).The incidence of postoperative complications in the observation group was 3.70%,which was significantly lower than 17.31%in the control group(P<0.05).After 1 year of postoperative follow-up,the intrauterine pregnancy rate of the observation group was 77.78%,which was significantly higher than 53.85%in the control group(P<0.05).Conclusion Laparoscopic salpingostomy for the treatment of unruptured tubal pregnancy can reduce bleeding volume,reduce the impact on ovarian function,and have high safety and a high postoperative intrauterine pregnancy rate,which has clinical application value.