不同手术方法治疗输卵管妊娠后对卵巢功能影响及生育结局的临床分析

目的:研究不同手术方法治疗输卵管妊娠后对卵巢功能及生育结局的近期影响。方法:在我院因不孕就诊患者输卵管妊娠121例,均行腹腔镜手术,行输卵管切除37例、输卵管切开取胚41例、部分输卵管切除43例,于术后1个月(月经第2～3天)、3个月(月经第2～3天)抽血测定卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)水平,并与基础激素水平比较,术后随访共2年了解其排卵及妊娠情况。结果:输卵管切除术患者术后1个月及3个月FSH、LH均增高、E2下降,较术前比较差异有统计学意义(P<0.05);术后半年排卵率为82.45%,术后妊娠率为39.62%;输卵管切开取胚术患者及输卵管部分切除术患者术后1个月、3个月激素水平与术前比较差异无统计学意义(P>0.05);术后半年排卵率分别为91.32%、89.51%,术后妊娠率为43.62%、45.71%;与输卵管切除术患者相比,排卵率及术后宫内妊娠率均稍高,但其差异无统计学意义(P>0.05);结论:输卵管病变的情况是决定手术方式的关键因素,尽量保留输卵管可以保留卵巢部分血供,避免影响手术后排卵率及妊娠率。

Clinical Analysis of the Different Surgical Methods for Treatment of Tubal Pregnancy on Ovarian Function and Reproductive Outcome

Objective:Study of immediate impact on ovarian function and fertility outcomes after different surgical methods for treatment of tubal pregnancy.Methods:Infertility treatment in patients with tubal pregnancy in 121 cases.All patients underwent laparoscopic surgery,tubal resection in 37 cases,41 cases of fallopian tubes cut to take the embryo surgery,partial salpingectomy in 43 cases,comparison of follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2)preoperative,postoperative 1 month,3 months after surgery,patients were followed up for 2 years to understand their ovulation and pregnancy.Results:FSH and LH were significantly higher in patients with salpingectomy after 1 month and 3 month,compared with the preoperative,E2 decreased.Difference was statistically significant(P<0.05);after six months ovulation rate was 82.45%,the postoperative pregnancy rate was 39.62%;the remaining two groups of patients after one month,three months hormone levels compared with the preoperative were no significant differences(P>0.05);months after operation ovulation rates were 91.32%,89.51%,the postoperative pregnancy rate was 43.62%,45.71%;compared with patients with salpingectomy,ovulation rate and postoperative intrauterine pregnancy rates were slightly higher,but the difference was not statistically significance(P>0.05).Conclusion:Tubal lesions is a key factor in determining the surgical approach to preserve the fallopian tube can retain the ovarian part of the blood supply,to avoid affecting the ovulation rate and pregnancy rate after surgery.