腹腔镜下全子宫切除术中切除双侧输卵管对患者围术期指标及卵巢储备功能的影响(1)
【摘要】 目的：探究腹腔鏡下全子宫切除术中切除双侧输卵管的可行性与临床意义。方法：回顾性分析本院行全子宫切除术的80例患者临床资料，术中切除双侧输卵管者纳入观察组(n=37)，其余患者纳入对照组(n=43)。比较两组术前及术后3个月的血清性激素[雌二醇(E2)、卵泡刺激素(FSH)、黄体生成素(LH)]、血清抗苗勒氏管激素(AMH)、窦卵泡数目(AFC)、围绝经期症状(改良Kupperman评分)变化，分析两组围术期指标及术后3个月内并发症发生情况。结果：术后3个月，两组血清E2水平均低于术前，FSH、LH水平均高于术前，且观察组血清E2水平低于对照组，FSH、LH水平均高于对照组，差异均有统计学意义(P<0.05);术后3个月，两组AMH、AFC水平均低于术前，改良Kupperman评分均高于术前，差异均有统计学意义(P<0.05)，但两组AMH、AFC水平及改良Kupperman评分比较，差异均无统计学意义(P>0.05);两组手术时间、术中出血量、肛门排气时间及住院时间比较，差异均无统计学意义(P>0.05);术后3个月内，两组皮下气肿、下肢深静脉血栓、阴道残端感染及输卵管脱垂发生率比较，差异均无统计学意义(P>0.05)，而观察组盆腔包裹性积液发生率低于对照组(P<0.05)。结论：腹腔镜下全子宫切除术中切除双侧输卵管将对患者近期性激素分泌功能造成一定负面影响，但术后整体卵巢储备功能及表观围绝经期症状严重程度并未显著受到输卵管切除影响，手术可操作性与安全性均属良好，术式可行性强，对改善患者远期预后有积极意义。
【关键词】 腹腔镜 全子宫切除术 输卵管切除 卵巢储备功能
[Abstract] Objective： To explore the feasibility and clinical significance of bilateral salpingectomy during laparoscopic total hysterectomy. Method： The clinical data of 80 patients who underwent total hysterectomy in our hospital were retrospectively analyzed. The patients who underwent bilateral salpingectomy were included in observation group (n=37)， and the remaining patients were included in control group (n=43). The serum sex hormones [estradiol (E2)， follicle stimulating hormone (FSH)， luteinizing hormone (LH)]， serum anti-Mullerian hormone (AMH)， antral follicle count (AFC) and perimenopausal symptoms (modified Kupperman score) were compared between the two groups before surgery and at 3 months after surgery. The perioperative indexes and incidence of complications within 3 months after surgery were analyzed in the two groups. Result： At 3 months after surgery， the level of serum E2 in the two groups were lower than those of before surgery， and the levels of FSH and LH were higher than those of before surgery， the serum E2 level of the observation group was lower than that of the control group， and the levels of FSH and LH were higher than those of the control group， the differences were statistically significant (P<0.05). At 3 months after surgery， the AMH and AFC levels were lower than those of before surgery， modified Kupperman scores of the two groups were higher than those of before surgery， the differences were statistically significant (P<0.05)， but the AMH， AFC levels and modified Kupperman scores of the two groups were compared， the differences were not statistically significant (P>0.05). There were no significant differences between the two groups in operation time， bleeding volume， anal exhaust time and hospitalization time (P>0.05). The incidence of subcutaneous emphysema， lower extremity deep vein thrombosis， vaginal stump infection and fallopian tube prolapse between the two groups within 3 months after operation were compared， the differences were not statistically significant (P>0.05)， the incidence of pelvic encapsulated effusion in the observation group was lower than that in the control group (P<0.05). Conclusion： Bilateral salpingectomy in laparoscopic total hysterectomy will have a negative impact on the short-term sexual hormone secretion function of the patients， but the overall ovarian reserve function and the severity of the apparent perimenopausal symptoms are not significantly affected by salpingectomy， the operability and safety of the operation are good， the feasibility of the operation is strong， and the long-term prognosis of the patients has a positive significance., 百拇医药(艾冬娥)
【关键词】 腹腔镜 全子宫切除术 输卵管切除 卵巢储备功能
[Abstract] Objective： To explore the feasibility and clinical significance of bilateral salpingectomy during laparoscopic total hysterectomy. Method： The clinical data of 80 patients who underwent total hysterectomy in our hospital were retrospectively analyzed. The patients who underwent bilateral salpingectomy were included in observation group (n=37)， and the remaining patients were included in control group (n=43). The serum sex hormones [estradiol (E2)， follicle stimulating hormone (FSH)， luteinizing hormone (LH)]， serum anti-Mullerian hormone (AMH)， antral follicle count (AFC) and perimenopausal symptoms (modified Kupperman score) were compared between the two groups before surgery and at 3 months after surgery. The perioperative indexes and incidence of complications within 3 months after surgery were analyzed in the two groups. Result： At 3 months after surgery， the level of serum E2 in the two groups were lower than those of before surgery， and the levels of FSH and LH were higher than those of before surgery， the serum E2 level of the observation group was lower than that of the control group， and the levels of FSH and LH were higher than those of the control group， the differences were statistically significant (P<0.05). At 3 months after surgery， the AMH and AFC levels were lower than those of before surgery， modified Kupperman scores of the two groups were higher than those of before surgery， the differences were statistically significant (P<0.05)， but the AMH， AFC levels and modified Kupperman scores of the two groups were compared， the differences were not statistically significant (P>0.05). There were no significant differences between the two groups in operation time， bleeding volume， anal exhaust time and hospitalization time (P>0.05). The incidence of subcutaneous emphysema， lower extremity deep vein thrombosis， vaginal stump infection and fallopian tube prolapse between the two groups within 3 months after operation were compared， the differences were not statistically significant (P>0.05)， the incidence of pelvic encapsulated effusion in the observation group was lower than that in the control group (P<0.05). Conclusion： Bilateral salpingectomy in laparoscopic total hysterectomy will have a negative impact on the short-term sexual hormone secretion function of the patients， but the overall ovarian reserve function and the severity of the apparent perimenopausal symptoms are not significantly affected by salpingectomy， the operability and safety of the operation are good， the feasibility of the operation is strong， and the long-term prognosis of the patients has a positive significance., 百拇医药(艾冬娥)