腹腔镜下输卵管不同手术方式对输卵管积液患者远期效果的影响  

The Influence of Different Laparoscopic Tubal Surgery Patter on the Long-Term Outcome of Patients with Salpinx Effusion

作　　者：方海艳 王丽丽 马雅茹[1] 刘海瑛[1] FANG Haiyan;WANG Lili;MA Yaru;LIU Haiying(Qingdao University Affiliated Women and Children’s Hospital,Qingdao 266000,China;Department of Obstetrics,Qingzhou People’s Hospital,Qingdao 266000,China)

机构地区：[1]青岛大学附属妇女儿童医院,山东青岛266000 [2]青州市人民医院产科,山东青岛266000

出　　处：《中国医药指南》2023年第29期85-87,共3页Guide of China Medicine

摘　　要：目的 分析腹腔镜下输卵管整形修复术、腹腔镜下输卵管抽芯切除术、腹腔镜下输卵管结扎并造口术对输卵管积液复发的影响、对妊娠的影响以及对卵巢储备功能的影响。方法 选取接受输卵管积液手术的146例患者,据手术方法的不同进行分组,A组68例接受腹腔镜下双侧输卵管整形修复术,B组33例接受腹腔镜下患侧输卵管抽芯切除术,C组45例接受腹腔镜下患侧输卵管峡部结扎并伞端造口术。术后随访1年,比较3组间临床妊娠情况、输卵管积液复发情况,通过月经量、子宫内膜厚度、窦卵泡数、AMH、FSH、E_(2)评估卵巢功能情况。结果 3组间临床妊娠率差异无统计学意义(P> 0.05);在卵巢功能方面,B组与C组间差异无统计学意义,两组与A组间差异有统计学意义(P <0.05)。在积液复发情况方面,C组大于A组,B组无复发,3组间差异有统计学意义(P <0.05)。结论 3种术式均可改善输卵管积水不孕患者妊娠结局。输卵管整形修复术于有自然妊娠需求的患者是机会,妊娠方式选择机会多。输卵管抽芯切除术改善积液复发影响优势明显,卵巢功能影响较传统输卵管切除术明显改良,但仍有卵巢功能下降风险。输卵管结扎并造口术对积液复发影响小,卵巢功能影响较输卵管切除低。Objective To analyze the effects of laparoscopic salpingoplasty repair,laparoscopic tubal core extraction,laparoscopic tubal ligation and ostomy on tubal effusion recurrence,pregnancy and ovarian reserve.Methods One hundred and forty-six patients with hydrosalpinx were divided into three groups according to the surgical methods.Sixty-eight patients in group A underwent laparoscopic bilateral salpingoplasty.Group B(33 patients) underwent laparoscopic core-pulling salpingectomy.Group C(45 patients) underwent laparoscopic ligation of the isthmus of the fallopian tube and ostomy.The clinical pregnancy and fluid recurrence between the three groups were compared,and ovarian function was evaluated by menstrual flow,endometrial thickness,antral follicle count,AMH,FSH,and E_2.Results There was no significant difference in clinical pregnancy rate among the three groups(P>0.05).There was no significant difference in ovarian function between group B and group C,but there was significant difference between the latter two groups and group A(P<0.05).The recurrence of effusion in group C was greater than that in group A,and there was no recurrence in group B,and the difference between the three was statistically significant(P<0.05).Conclusions All three surgical methods can improve the pregnancy outcome of infertile patients with hydrosalpinx.Salpingoplasty is an opportunity for patients with natural pregnancy needs,and there are many opportunities for pregnancy methods.Tubal core extraction has obvious advantages in improving the recurrence of hydrops,and the effect of ovarian function is significantly improved compared with traditional salpingectomy,but there is still a risk of decreased ovarian function.Tubal ligation and ostomy had little effect on effusion recurrence.The effect of ovarian function is lower than that of salpingectomy.

关 键 词：输卵管积液 输卵管结扎并造口术 输卵管抽芯切除术 输卵管整形修复术 卵巢储备功能 妊娠结局 

分 类 号：R711.76[医药卫生—妇产科学]