CAJ | 학술논문

目的：探讨腹腔镜下抽芯法输卵管切除术对卵巢功能的影响。方法：选取2011年6月-2012年12月因输卵管积水不孕患者62例在江西省妇幼保健生殖健康中心行体外受精胚胎移植前预处理输卵管积水，根据患者意愿及手术方式分为三组，A组20例行腹腔镜下抽芯法输卵管切除术，B组20例行腹腔镜下输卵管远端造口近端离断术，C组22例行腹腔镜下传统输卵管切除术，比较三组手术前、后基础内分泌激素水平，基础窦卵泡数值及IVF-ET结局。结果：三组术前基础内分泌激素比较差异无统计学意义（P>0.05），C组FSH水平术后（14.89±7.15）IU/L与术前（6.11±2.71）IU/L比较有明显升高，差异有统计学意义（P<0.05）。三组术后LH及E2水平与术前比较差异无统计学意义（P>0.05）；C组基础窦卵泡数术后（5.5±4.8）个与术前（8.2±1.8）个比较显著降低，差异有统计学意义（P<0.05）。C组术后基础窦卵泡数值显著低于A、B两组；C组应用Gn用量均较其他两组多，比较差异均有统计学意义（P<0.05）；A、B两组获卵数均高于C组，但三组无统计学差异（P>0.05）。A组临床妊娠率（40.23%）高于B组（38.49%）和C组（27.28%），与C组比较差异有统计学意义（P<0.05）。结论：抽芯法输卵管切除术不影响卵巢储备功能，可提高临床妊娠率，是输卵管积水不孕患者行IVF-ET前预处理较理想的治疗方式。
목적：탐토복강경하추심법수란관절제술대란소공능적영향。방법：선취2011년6월-2012년12월인수란관적수불잉환자62례재강서성부유보건생식건강중심행체외수정배태이식전예처리수란관적수，근거환자의원급수술방식분위삼조，A조20례행복강경하추심법수란관절제술，B조20례행복강경하수란관원단조구근단리단술，C조22례행복강경하전통수란관절제술，비교삼조수술전、후기출내분비격소수평，기출두란포수치급IVF-ET결국。결과：삼조술전기출내분비격소비교차이무통계학의의（P>0.05），C조FSH수평술후（14.89±7.15）IU/L여술전（6.11±2.71）IU/L비교유명현승고，차이유통계학의의（P<0.05）。삼조술후LH급E2수평여술전비교차이무통계학의의（P>0.05）；C조기출두란포수술후（5.5±4.8）개여술전（8.2±1.8）개비교현저강저，차이유통계학의의（P<0.05）。C조술후기출두란포수치현저저우A、B량조；C조응용Gn용량균교기타량조다，비교차이균유통계학의의（P<0.05）；A、B량조획란수균고우C조，단삼조무통계학차이（P>0.05）。A조림상임신솔（40.23%）고우B조（38.49%）화C조（27.28%），여C조비교차이유통계학의의（P<0.05）。결론：추심법수란관절제술불영향란소저비공능，가제고림상임신솔，시수란관적수불잉환자행IVF-ET전예처리교이상적치료방식。
Objective:To investigate the effects of laparoscopic"core-pulling"salpingectomy for patients with hydrosalpinx on ovarian reserve. Method:Between June 2011 and December 2012,A total of 62 infertile females with hydrosalpinx receiving treatment in Reproductive Medicine Center of the Maternity and Child Healthcare Hospital of Jiangxi Province were divided into three groups according to the patients choice and different operation managements. Group A(n=20)was treated with"core-pulling"salpingectomy,group B(n=20)was treated with laparoscopic proximal tubal ligament and distal tubal salpingostomy,and group C(n=22)was treated with conventional salpingostomy. The level of endocrine hormone(FSH,LH,E2),the antral follicle count and the clinical outcome of IVF were compared between preoperation and post operation in three groups.Result:The preoperative level of endocrine hormone in three groups was no statistical difference(P>0.05),the FSH level after surgery in group C(14.89±7.15)IU/L was significantly increased compared with preoperative(6.11±2.71)IU/L,the postoperative LH and E2 level in three groups compared with preoperative had no significant change(P>0.05),the antral follicle count of group C after operation(5.5±4.8)compared with the preoperative(8.2±1.8)decreased significantly,and decreased significantly compared with the other groups,the Gn dosage in group C was more than other two groups,the difference was statistically significant(P<0.05);The number of retrieved oocytes in group A and B were higher than that of group C,but no statistical difference was found in three groups(P>0.05),the clinical pregnancy rate in group A(40.23%)was higher than the group B(38.4%)and group C(27.28%), the differences were statistically significant compared with group C(P<0.05). Conclusion:Laparoscopic "core-pulling" salpingectomy should be recommended for patients with hydrosalpinx intending to receive IVF-ET,which does not interfere with the ovarian reserve or responsiveness but improve the conception rate in clinical practice.