腹腔镜下输卵管积水不同处理方式对卵巢近期储备功能的影响

摘要

目的 研究腹腔镜下输卵管造口术(Salpingostomy)、输卵管近端离断远端造口术(Proximal tubal ligament and distal tubal salpingostomy)和输卵管切除术(Salpingectomy)对输卵管积水患者卵巢近期储备功能的影响.方法 回顾性分析2009年1月至2011年12月襄阳市中心医院妇产科诊治的115例输卵管积水患者的临床资料,根据腹腔镜处理方式分为输卵管造口术组(OST组)、输卵管近端离断远端造口术组(LIG组)和输卵管切除术组(ECT组),另以同期腹腔镜探查无输卵管积水、不明原因不孕的患者为对照组(CON组).术后采用电化学发光法检测性激素水平,采用阴道超声检测卵巢体积和窦卵泡数,比较四组研究对象手术前后性激素、卵巢体积和窦卵泡数的差异.结果 (1) OST组、LIG组和ECT组手术前FSH差异无统计学意义,手术后均降低；LIG组术后FSH低于OST组和ECT组.OST组、LIG组和ECT组手术前后FSH显著高于CON组；(2) OST组、LIG组和ECT组手术前LH无明显差异,手术后均升高,但差异无统计学意义.OST组、LIG组和ECT组手术前LH均低于CON组(均P＞0.05),手术后均高于CON组；(3) OST组、LIG组和ECT组手术前E2差异无统计学意义,手术后均显著降低(均P＜0.05),LIG组低于OST组和ECT组(均P＞0.05).OST组、LIG组和ECT组手术前和手术后E2均高于CON组(均P＜0.05).CON组手术前后E2差异无统计学意义；(4) OST组、LIG组和ECT组患者手术前卵巢体积差异无统计学意义(均P＞0.05),手术后均升高,LIG组高于OST组和ECT组.OST组、LIG组和ECT组患者手术前和手术后的卵巢体积均低于CON组,其中手术前的差异具有统计学意义(均P＜0.05).CON组手术前后的卵巢体积差异无统计学意义；OST组、LIG组和ECT组患者手术前的窦卵泡数差异无统计学意义,均低于CON组手术后OST组、LIG组和ECT组窦卵泡数均显著升高,OST组、LIG组、ECT组和CON组术后的窦卵泡数差异无统计学意义.结论 腹腔镜下输卵管造口术、输卵管近端离断远端造口术和输卵管切除术均可改善卵巢近期储备功能,但输卵管近端离断远端造口术及输卵管造口术优于输卵管切除术.%Objective To study the effect of different laparoscopic managements to hydrosalpinx on the short-term ovarian reserve. Methods The clinical data of 115 patients with hydrosalpinx treated in our hospital from Jan. 2009 and Dec. 2011 were retrospectively analyzed. The patients were divided into three groups according to the laparoscopic managements: OST group (treated by laparoscopic salpingostomy), LIG group (treated by proximal tubal ligament and distal tubal salpingostomy) and ECT group (treated by salpingectomy). The patients without hydrosalpinx diagnosed by laparoscopy were selected as the control group (CON group). Follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2) were detected by EMMCIA. Ovarian volume and antral follicle were detected by transvaginal ultrasound. The preoperative and postoperative differences of FSH, LH, E2, ovarian volume and antral follicle were compared between the four groups. Results (1) The levels of FSH in OST group, LIG group and ECT group weren't significantly different before surgery, which decreased after surgery (P＜0.05). The postoperative level of FSH in LIG group was lower than that in OST group and ECT group (P>0.05). The preoperative and postoperative levels of FSH in OST group, LIG group and ECT group were significantly higher than that in the CON group. (2) The levels of LH in OST group, LIG group and ECT group showed no statistically significant difference both before and after surgery, and the levels after surgery were higher than those before surgery. The levels of LH in the OST group, LIG group and ECT group were lower than that in CON group before surgery, but higher after surgery. (3) The levels of E2 in OST group, LIG group and ECT group weren't significantly different before surgery, which decreased after surgery (P>0.05). The postoperative E2 in LIG group was lower than in OST and ECT group (P>0.05). The preoperative and postoperative levels of E2 in the OST group, LIG group and ECT group were all higher than those in the CON group. (4) The OST group, LIG group and ECT group showed no statistically significant difference in preoperative ovarian volume and antral follicle (P>0.05), which were increased after surgery. LIG group showed higher postoperative ovarian volume and antral follicle than OST group and ECT group (P>0.05). The preoperative and postoperative ovarian volume and antral follicle were higher in OST group, LIG group and ECT group than the CON group. Conclusion Hydrosalpinx could reduce the ovarian function. Laparoscopic salpingostomy, Proximal tubal ligament and distal tubal salpingostomy, as well as salpingectomy could all improve ovarian short-term reserve to certain extent, but the effect of proximal tubal ligament and distal tubal salpingostomy as well as laparoscopic salpingostomy are better.