腹腔镜下单侧输卵管切除术对输卵管妊娠患者血清β-hCG、Netrin-1及术后妊娠影响

Effects of laparoscopic unilateral salpingectomy for treating patients with tubal pregnancy on their serumβ-human chorionic gonadotropin and Netrin-1 levels and postoperative pregnancy

目的:探讨腹腔镜下单侧输卵管切除术对输卵管妊娠患者血清β-人绒毛膜促性腺激素(β-hCG)、神经轴突导向因子-1(Netrin-1)水平及对术后妊娠的影响。方法:选取2021年1月-2022年11月本院行腹腔镜下单侧输卵管切除术患者40例(观察组)、腹腔镜下单侧输卵管开窗取胚术患者40例(对照组),统计手术相关指标、并发症,手术前后血清β-hCG、Netrin-1水平以及术后卵巢储备功能指标,随访术后1年内妊娠情况。结果:观察组术中出血量(72.1±4.8ml)多于对照组(66.1±12.4ml),术后并发症发生率(7.5%)和术后继续异位妊娠率(0)低于对照组(25.0%、17.5%);术后6个月,血清促黄体激素(6.15±1.12mU/ml)高于对照组(5.63±0.95mU/ml),抗缪勒管激素(3.33±0.58ng/ml)低于对照组(3.64±0.79ng/ml)(均P<0.05)。两组术后第3dβ-hCG、Netrin-1水平及术后β-hCG、Netrin-1降低至正常水平时间也无差异(均P>0.05)。结论:腹腔镜下单侧输卵管切除术、输卵管开窗取胚术均能有效清除异位着床组织,但腹腔镜下单侧输卵管切除术术后并发症和再次异位妊娠风险更低,但存在术中出血量多、损伤卵巢储备功能风险。

Objective:To investigate the effects of laparoscopic unilateral salpingectomy for treating patients with tubal pregnancy on their serumβ-human chorionic gonadotropin(β-hCG)and Netrin-1levels and postoperative pregnancy.Methods:From January 2021to November 2022,40patients with tubal pregnancy who underwent laparoscopic unilateral salpingectomy(in observation group)and 40patients with tubal pregnancy who underwent laparoscopic unilateral fallopian tubal fenestration for removing the embryo(in control group)were selected in this study.The surgery-related indicators,the complications,the serumβ-hCG and Netrin-1levels before and after surgery and the postoperative ovarian reserve function indicators of the patients in the two groups were counted.The pregnancy status within 1year after surgery of the patients in the two groups was followed up.Results:The intraoperative blood loss(72.1±4.8ml)of the patients in the observation group was significantly more than that(66.1±12.4ml)of the patients in the control group.The incidence of the postoperative complications(7.5%)and the rate of postoperative ectopic pregnancy(0)of the patients in the observation group were significantly lower than those(25.0%and 17.5%)of the patients in the control group.In 6months after surgery,the serum luteinizing hormone level(6.15±1.12mU/ml)of the patients in the observation group was significantly higher than that(5.63±0.95mU/ml)of the patients in the control group,and the anti-Mullerian hormone level(3.33±0.58ng/ml)of the patients in the observation group was significantly lower than that(3.64±0.79ng/ml)of the patients in the control group(all P<0.05).There were no significant differences in the levels ofβ-hCG and Netrin-1on the 3rd day after surgery and the time of the levels ofβ-hCG and Netrin-1decreasing to normal after surgery of the patients between the two groups(all P>0.05).Conclusion:Laparoscopic unilateral salpingectomy and fallopian tubal fenestration for treating the patients with tubal pregnancy can effectively remove the ectopically implanted embryo.Compared with those of fallopian tubal fenestration,laparoscopic unilateral salpingectomy can reduce the postoperative complications and the risk of ectopic pregnancy again of the patients,but which has the risks of more intraoperative bleeding and damaging the ovarian reserve function of the patients.