输卵管妊娠腹腔镜下不同手术方式对卵巢功能的影响

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。方法分析119例输卵管妊娠患者的临床资料,所有患者均行腹腔镜手术,并根据手术方式分为3组：输卵管切开取胚术37例（A组）、输卵管部分切除术39例（B组）、输卵管切除术43例（C组）。分别于术后第1、3、6个月经周期（月经2～4 d）抽血测定卵泡刺激素（FSH）、黄体生成素（LH）、雌二醇（E2）水平,并与术前基础激素水平比较,同时监测基础窦卵泡数（AFC）。术后随访月经复潮时间及术后3个月内的排卵情况。结果①3组术前、术后激素水平都在卵泡期激素正常范围内。C组与A、B组比较于术后第1个月经周期FSH升高、E2下降及患侧卵巢AFC减少（P〈0.05）。②C组内,在术后第1个月经周期FSH高于术前,E2低于术前,患侧卵巢AFC少于术前及健侧（P〈0.05）。③其他比较差异无统计学意义（P〉0.05）。④C组月经复潮时间比A、B组长（P〈0.05）。⑤3组术后3个月排卵率差异无统计学意义（P〉0.05）。结论腹腔镜输卵管切除术对患者近期的卵巢功能有一定的影响,于术后3个月卵巢功能可恢复正常;腹腔镜治疗输卵管妊娠的手术中应最大限度地保护卵巢血供。

Influence on ovarian function by different operation methods under laparoscope in treatment of salpingocyesis

Objective To explore the influence on ovarian reserve function by different operation methods under laparoscope in treatment of treat salpingocyesis. Methods Clinical data from 119 cases of patients with salpingocyesis were analyzed.They were all carried out laparoscopic surgery.According to different surgical methods,they were divided into 3groups：taking embryon from salpingotomy（group A,n=37）,partial excision fallopian tube（group B,n=39）,and salpingectomy（group C,n=43）.The levels of follicle-stimulating hormone（FSH）,luteinizing hormone（LH）,and estradiol（E2） were tested by drawing blood the 1st,3rd,and 6thmenstrual cycles（2ndto 4thday during menstruation） after surgery.The out comes and preoperative hormone levels were compared.The antral follicle count（AFC） was monitored as well.The postoperative follow up visits focused on time of restoring menstruation and 3-month ovulations after surgery. Results①The levels of hormones before and after surgery were in normal range at follicular phase.In comparison with group A and group B,the FSH increased,E2decreased,and AFC in affected side reduced in the first menstrual period after surgery in group C（P〈0.05）.②In group C,the FSH in the first menstrual period after surgery was higher and E2was less in comparison with those before surgery.AFC in affected side was less than that before surgery and uninjured side（P〈0.05）.③There was no statistical difference in others related to levels of hormones and antral follicle count.④The time of restoring menstruation in group C was longer than that in group A and group B（P〈0.05）.⑤There was no significant difference in ovulation rate 3 months after surgery among 3 groups（P〉0.05）. Conclusion Salpingectomy under laparoscope has certain influence on near-term ovarian function,but the ovarian function can return to normal 3 months after surgery.The blood supply of ovarian should be protected in maximum in process of laparoscopic surgery to treat salpingocyesis.