腹腔镜下输卵管开窗术和切除术对输卵管妊娠患者卵巢储备功能和临床预后的影响  

Effect of laparoscopic salpingectomy and laparoscopic salpingostomy on ovarian reserve function and clinical prognosis in patients with tubal pregnancy salpingostomy

作　　者：黄文娟 施灵美 HUANG Wen-juan;SHI Ling-mei(Yongkang Maternal&Child Health Care Hospital,Yongkang 321300)

机构地区：[1]永康市妇幼保健院,永康321300

出　　处：《生殖医学杂志》2024年第10期1340-1345,共6页Journal of Reproductive Medicine

摘　　要：目的研究腹腔镜下输卵管开窗术和切除术对输卵管妊娠患者卵巢储备功能和临床预后的影响。方法选择2020年1月至2022年12月本院收治的86例输卵管妊娠患者为研究对象,根据手术方式不同分为输卵管切除组(切除组,n=43)和输卵管开窗组(开窗组,n=43),比较两组患者围术期指标、血清激素水平、卵巢储备功能和临床预后。结果(1)两组患者间手术时间、排气时间、术中出血量、住院时间和术后并发症的差异均无统计学意义(P>0.05)。(2)术后6个月,开窗组患者血清FSH和LH水平均显著低于切除组[分别为(3.71±0.56)U/L vs.(5.72±0.73)U/L,(5.62±0.56)U/L vs.(7.14±0.67)U/L,P<0.05],雌二醇(E 2)和抗苗勒管激素(AMH)水平显著高于切除组[分别为(255.03±28.08)pmol/L vs.(212.27±21.32)pmol/L,(3.54±0.36)ng/ml vs.(2.45±0.31)ng/ml,P<0.05]。(3)术后6个月时开窗组患者卵巢直径(MOD)、窦卵泡计数(AFC)、卵巢平均容积(OAV)、卵巢基质动脉收缩峰值血流速度(PSV)和舒张末期血流速度(EDV)均较切除组显著升高(P<0.05),而阻力指数(RI)水平较切除组显著降低(P<0.05)。(4)开窗组患者随访1年宫内妊娠率显著高于切除组(83.72%vs.48.84%,P<0.05),异位妊娠率和继发不孕率显著低于切除组(P<0.05)。结论腹腔镜下输卵管开窗术在改善卵巢储备功能和临床预后方面较输卵管切除术更有优势。Objective:To investigate the effect of laparoscopic salpingostomy and salpingectomy on ovarian reserve function and clinical prognosis in patients with tubal pregnancy.Methods:A total of 86 patients with tubal pregnancy who underwent laparoscopic surgery in Yongkang Maternal&Child Health Care Hospital from January 2020 to December 2022 were included in this study.According to the random number table,they were divided into the salpingectomy group(n=43)and the salpingostomy group(n=43).The perioperative indexes,serum hormone level,ovarian reserve function and clinical prognosis were compared between the two groups.Results:There were no significant differences in the operation time,anal exhaust time,the amount of intraoperative blood loss,the duration of hospital stay and postoperative complications between two groups(P>0.05).At the sixth month after operation,the serum levels of FSH and LH in the salpingostomy group were significantly lower than those in the salpingectomy group[(3.71±0.56)U/L vs.(5.72±0.73)U/L,(5.62±0.56)U/L vs.(7.14±0.67)U/L,respectively,P<0.05],but the serum levels of estradiol(E 2)and anti-Müllerian hormone(AMH)in salpingostomy group were significantly higher than those in salpingectomy group[(255.03±28.08)pmol/L vs.(212.27±21.32)pmol/L,(3.54±0.36)ng/ml vs.(2.45±0.31)ng/ml,respectively,P<0.05].At the sixth month after operation,the ovarian diameter(MOD),antral follicle count(AFC),ovarian average volume(OAV),peak systolic velocity(PSV)and end diastolic velocity(EDV)of ovarian stromal arteries in the salpingostomy group were significantly higher than those of the salpingectomy group(P<0.05),but the level of resistance index(RI)in salpingostomy group was significantly lower than that in salpingectomy group(P<0.05).The intrauterine pregnancy rate in one-year follow-up in the salpingostomy group was significantly higher than that in the salpingectomy group(83.72%vs 48.84%,P<0.05),while the ectopic pregnancy rate and secondary infertility rate were significantly lower than those in salpingect

关 键 词：输卵管妊娠 输卵管开窗术 输卵管切除术 腹腔镜 卵巢储备 临床预后 

分 类 号：R711[医药卫生—妇产科学] R714.22[医药卫生—临床医学]