输卵管手术影响不孕女性卵巢储备功能的相关研究  

Effect of tubal surgeries on ovarian reserve function in female infertility

作　　者：刘晓洁 郭小妮 莫小纳 叶虹 Liu Xiaojie;Guo Xiaoni;Mo Xiaona;Ye Hong(Department of Clinical Medicine,Reproductive Medicine Center,Chongqing Health Center for Women and Children,Women and Children’s Hospital of Chongqing Medical University)

机构地区：[1]重庆医科大学附属妇女儿童医院/重庆市妇幼保健院/生殖医学中心临床医学部,重庆401147

出　　处：《重庆医科大学学报》2025年第1期130-134,共5页Journal of Chongqing Medical University

摘　　要：目的:评估不同输卵管处理方式对不孕患者的卵巢储备状况和辅助生殖技术(assisted reproductive technology,ART)结果的影响。方法:2017年1月至2022年9月在重庆市妇幼保健院生殖医学中心所行ART的11316例患者,分为未行手术组(n=4732)、输卵管保守手术组(n=4578)、输卵管结扎/切除术组(n=2006),主要观察指标是血清抗苗勒氏管激素(anti-Müllerian hormone,AMH)、基础窦卵泡数(antral-follicle-count,AFC)、基础促卵泡激素(follicle-stimulating hormone,FSH)、获卵数和可移植胚胎数。采用单因素方差分析、卡方检验和广义线性模型(generalize linear model,LSD)进行分析。结果:与未手术组相比,输卵管保守手术组卵巢储备功能明显下降,AMH(OR=0.736,95%CI=0.668~0.811,P=0.001)、基础FSH(OR=1.171,95%CI=1.064~1.288,P=0.001)、AFC(OR=0.600,95%CI=0.519~0.693,P=0.001)、获卵数(OR=0.569,95%CI=0.439~0.739,P=0.001)、胚胎移植数(OR=0.788,95%CI=0.703~0.883,P<0.001)。输卵管结扎/切除术组与未手术组相比也出现卵巢储备功能明显下降,AMH(OR=0.752,95%CI=0.660~0.856,P<0.001)、基础FSH(OR=1.160,95%CI=1.021~1.318,P<0.05)和AFC计数(OR=0.549,95%CI=0.453~0.665,P<0.001)。但输卵管结扎/切除术组与输卵管保守手术组相比,在AMH、基础FSH、AFC计数、获卵数方面无差异,但MII卵数(OR=1.564,95%CI=1.129~2.167,P=0.007)和胚胎移植数量(OR=1.270,95%CI=1.091~1.479,P=0.002)有正面影响。结论:对输卵管进行结扎/切除或保守手术,术后女性的卵巢储备功能均下降。但输卵管结扎/切除,与保守手术相比,对卵巢储备功能下降的影响程度无差异。Objective:To assess the effect of different tubal treatments on ovarian reserve status and assisted reproductive technology(ART)outcomes in infertile patients.Methods:This study included 11316 patients receiving ART in Chongqing Institute of Reproduction and Genetics,Chongqing Health Center for Women and Children from January 2017 to September 2022.The patients were divided into three groups:non-surgery group(n=4732),conservative tubal surgery group(n=4578),and tubal ligation/salpingectomy group(n=2006).The primary outcome measures were serum anti-mullerian hormone(AMH),basic antral follicle count(AFC),basic follicle-stimulating hormone(FSH),number of oocytes retrieved,and number of transferable embryos.One-way analysis of variance,chi-square test,and generalized linear model(least significant difference)were used for analysis.Results:Compared with the nonsurgery group,the patient’ovarian reserve function decreased significantly in the conservative tubal surgery group,with significant differences in AMH(OR=0.736,95%CI=0.668-0.811,P=0.001),basic FSH(OR=1.171,95%CI=1.064-1.288,P=0.001),AFC(OR=0.600,95%CI=0.519-0.693,P=0.001),number of oocytes retrieved(OR=0.569,95%CI=0.439-0.739,P=0.001),and number of transferable embryos(OR=0.788,95%CI=0.703-0.883,P<0.001);the ovarian reserve function also decreased significantly in the tubal ligation/salpingectomy group,with significant differences in AMH(OR=0.752,95%CI=0.660-0.856,P<0.001),basic FSH(OR=1.160,95%CI=1.021-1.318,P<0.05),and AFC(OR=0.549,95%CI=0.453-0.665,P<0.001).No significant differences were observed in AMH,basic FSH,AFC,and number of oocytes retrieved between the tubal ligation/salpingectomy group and the conservative tubal surgery group,but there were positive effects on the number of meta-phaseⅡoocytes(OR=1.564,95%CI=1.129-2.167,P=0.007)and number of transferable embryos(OR=1.270,95%CI=1.091-1.479,P=0.002).Conclusion:The ovarian reserve function decreases in infertile women after tubal ligation/salpingectomy or conservative tubal surgery.However,tubal lig

关 键 词：辅助生殖助孕 卵巢储备功能 输卵管手术 

分 类 号：R715.5[医药卫生—妇产科学]