输卵管妊娠腹腔镜下不同手术方式对卵巢储备功能的影响  

The Influence on the Ovarian Reserve Function after Different Laparoscopic Operations of Tubal Pregnancy

作　　者：谢秋娴[1] 杨纯[1] 郑曼嘉[1] 黄韩蔚[1] 陈婵玉[1] 

机构地区：[1]南方医科大学附属潮州市中心医院妇科,广东潮州521021

出　　处：《临床医学工程》2012年第3期356-358,共3页Clinical Medicine & Engineering

基　　金：广东省科技计划项目(2011B031800058)

摘　　要：目的探讨输卵管妊娠腹腔镜下不同手术方式对卵巢储备功能的影响。方法选择2010年6月至2011年6月期间在我院妇科行妇科腹腔镜手术的输卵管妊娠患者60例,并选择同期健康志愿者20例。60例输卵管妊娠患者根据手术方式随机分为3组:A组(腹腔镜输卵管开窗妊娠物取出术组),B组(腹腔镜输卵管伞端妊娠物挤出术组),C组(腹腔镜输卵管切除术),每组各20例。采用放射免疫法检测四组患者术前、术后1月、6月的卵泡刺激素(FSH)、黄体生成素(LH)、雌二酮(E2)、黄体酮(P)、睾酮(T)水平;采用经阴道彩色多普勒超声检测术前、术后1月、6月卵巢基质内动脉血流参数、卵巢截面积;术后6个月患者月经异常、围绝经期综合征发生率;术后排卵是否正常;术后妊娠率情况。结果①四组患者一般情况比较无明显差异(P>0.05);②术后1个月和术后6个月时:C组FSH、LH水平比A组、B组明显增高(P<0.05),E2、P、T水平比A组、B组明显降低(P<0.05);③术后1个月时和术后6个月时:C组PSV、EDV、卵巢截面积比A、B组明显降低(P<0.05),RI比A组、B组明显增高(P<0.05);④术后6个月随访:C组恢复排卵率及妊娠率比A组、B组明显降低(P<0.05);三组输卵管妊娠患者在月经异常、围绝经期综合征发生率方面无明显差异(P>0.05)。结论腹腔镜输卵管切除术对患者远期的卵巢储备功能存在一定的影响,对有生育要求的妇女应尽可能行保守性手术以保护卵巢功能。Objective To explore the influence on the ovarian reserve function after different laparoscopic operations of tubal preg nancy. Methods 60 patients with tubal pregnancy and another twenty health volunteers were selected. 60 cases of tubal pregnancy were di vided into three groups based on the operation method： laparoscopic fenestration and embryo-taken surgery （group A）, laparoscopic tubal fimbria gravid extrusion surgery （group B） and laparoscopic salpingectomy （group C）. The hormone levels including follicle stimulating hormone （FSH）, luteinizing hormone （LH）, estradiol 2 （E2）, progesterone （P） and testosterone （T） 1 month, 6 month before and after operation were deteceted by radio immuno assay; the ovarian artery homodynamic parameter and ovarian size 1 month, 6 month before and after operation were deteceted by B ultrasound monitoring; the incidences of irregular menstruation and climacteric syndrome 6 month after surgery, postoperative ability of pregnancy and recovery of ovulation were followed-up. Results （1）There were no significant differences in patients＇ background among four groups （P 〉0.05）; （2） Compared to Group A or B： the FSH and LH levels increased significantly and the E2, P, T levels decreased significantly in group C at the first and sixth month after surgery （P 〈0.05）; （3）Compared to Group A or B： the RI value increased significantly and the PSV, EDV and ovarian size values all decreased significantly in group C at the first and sixth month after surgery （P 〈0.05）; （4） At the six month after surgery, the ability of pregnancy and recovery of ovulation decresed significantly in Group C compared with Group A or B （P 〈0.05）; There were no significant differences of the menstruation flow and climacteric syndrome, among A, B and C group （P 〉0.05）. Conclusions Laparoscopic salpingectomy may have detrimental effects on ovarian reserve function, so we should try our best to reserve the salpinx during tubal prenancy o

关 键 词：输卵管妊娠 腹腔镜 卵巢储备功能 

分 类 号：R713.8[医药卫生—妇产科学]