中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2015年
6期
414-418
,共5页
绝育,输卵管%妊娠,输卵管%生殖潜能
絕育,輸卵管%妊娠,輸卵管%生殖潛能
절육,수란관%임신,수란관%생식잠능
Sterilization,tubal%Pregnancy,tubal%Reproductive potential
目的 分析并探讨输卵管切除术对育龄女性生殖潜能的影响.方法 选取输卵管妊娠患者246例,其中164例为研究组,行患侧输卵管切除术;82例为对照组,行保留患侧输卵管的治疗;测定两组患者的性激素水平、卵巢体积、窦卵泡数量、排卵率及生育结局,比较两组患者生育状况.研究组失访7例,对照组失访3例.结果 研究组治疗后血清β-人绒毛膜促性腺激素(β-hCG)恢复正常起1,3,6个月血清卵泡刺激素(FSH)、黄体生成素(LH)水平均高于对照组[FSH:(10.00± 4.82) U/L比(6.69±2.71) U/L、(9.11±3.77)U/L比(6.81±2.80) U/L、(8.30±3.49)U/L比(6.41 ±2.41)U/L;LH:(8.74±3.56) U/L比(6.10±2.59) U/L、(9.42±3.09) U/L比(5.79±2.10)U/L、(7.96±2.53)U/L比(6.50±2.71) U/L],差异有统计学意义(P＜0.05).研究组治疗后血清β-hCG恢复正常起1,3个月血清雌二醇(E2)和抗苗勒管激素(AMH)水平低于对照组[E2:(111.44±22.24)pmol/L比(128.22±24.01) pmol/L,(108.74±21.67) pmol/L比(126.30±23.78) pmol/L;AMH:(3.22±0.85)μg/L比(3.64±0.87) μg/L,(3.67±0.94) μ g/L比(3.83±1.12) μg/L],差异有统计学意义(P＜ 0.05);6个月时两组血清E2和AMH水平比较差异无统计学意义[E2:(127.85±24.42) pmol/L比(131.28±25.54) pmol/L;AMH:(4.35±1.34)μg/L比(4.47± 1.76) μg/L](P＞0.05).输卵管切除患者术后6个月患侧(输卵管切除侧)卵巢体积、窦卵泡数显著低于对侧[(8.86±2.36) cm3比(9.74±2.31) cm3、(5.10±1.14)个比(7.26±2.52)个],差异有统计学意义(P＜0.05).术后2年对照组异位妊娠率高于研究组[12.66％(10/79)比5.10％(8/157)],差异有统计学意义(P＜0.05);尤其术中保留的输卵管再次异位妊娠率更高[8.86％(7/79)比0],差异有统计学意义(P＜0.05).结论 输卵管切除术影响患者生殖潜能,但可降低再次异位妊娠的发生率.输卵管妊娠患者是否行输卵管切除术,取决于输卵管的病变情况及患者的生育要求.
目的 分析併探討輸卵管切除術對育齡女性生殖潛能的影響.方法 選取輸卵管妊娠患者246例,其中164例為研究組,行患側輸卵管切除術;82例為對照組,行保留患側輸卵管的治療;測定兩組患者的性激素水平、卵巢體積、竇卵泡數量、排卵率及生育結跼,比較兩組患者生育狀況.研究組失訪7例,對照組失訪3例.結果 研究組治療後血清β-人絨毛膜促性腺激素(β-hCG)恢複正常起1,3,6箇月血清卵泡刺激素(FSH)、黃體生成素(LH)水平均高于對照組[FSH:(10.00± 4.82) U/L比(6.69±2.71) U/L、(9.11±3.77)U/L比(6.81±2.80) U/L、(8.30±3.49)U/L比(6.41 ±2.41)U/L;LH:(8.74±3.56) U/L比(6.10±2.59) U/L、(9.42±3.09) U/L比(5.79±2.10)U/L、(7.96±2.53)U/L比(6.50±2.71) U/L],差異有統計學意義(P＜0.05).研究組治療後血清β-hCG恢複正常起1,3箇月血清雌二醇(E2)和抗苗勒管激素(AMH)水平低于對照組[E2:(111.44±22.24)pmol/L比(128.22±24.01) pmol/L,(108.74±21.67) pmol/L比(126.30±23.78) pmol/L;AMH:(3.22±0.85)μg/L比(3.64±0.87) μg/L,(3.67±0.94) μ g/L比(3.83±1.12) μg/L],差異有統計學意義(P＜ 0.05);6箇月時兩組血清E2和AMH水平比較差異無統計學意義[E2:(127.85±24.42) pmol/L比(131.28±25.54) pmol/L;AMH:(4.35±1.34)μg/L比(4.47± 1.76) μg/L](P＞0.05).輸卵管切除患者術後6箇月患側(輸卵管切除側)卵巢體積、竇卵泡數顯著低于對側[(8.86±2.36) cm3比(9.74±2.31) cm3、(5.10±1.14)箇比(7.26±2.52)箇],差異有統計學意義(P＜0.05).術後2年對照組異位妊娠率高于研究組[12.66％(10/79)比5.10％(8/157)],差異有統計學意義(P＜0.05);尤其術中保留的輸卵管再次異位妊娠率更高[8.86％(7/79)比0],差異有統計學意義(P＜0.05).結論 輸卵管切除術影響患者生殖潛能,但可降低再次異位妊娠的髮生率.輸卵管妊娠患者是否行輸卵管切除術,取決于輸卵管的病變情況及患者的生育要求.
목적 분석병탐토수란관절제술대육령녀성생식잠능적영향.방법 선취수란관임신환자246례,기중164례위연구조,행환측수란관절제술;82례위대조조,행보류환측수란관적치료;측정량조환자적성격소수평、란소체적、두란포수량、배란솔급생육결국,비교량조환자생육상황.연구조실방7례,대조조실방3례.결과 연구조치료후혈청β-인융모막촉성선격소(β-hCG)회복정상기1,3,6개월혈청란포자격소(FSH)、황체생성소(LH)수평균고우대조조[FSH:(10.00± 4.82) U/L비(6.69±2.71) U/L、(9.11±3.77)U/L비(6.81±2.80) U/L、(8.30±3.49)U/L비(6.41 ±2.41)U/L;LH:(8.74±3.56) U/L비(6.10±2.59) U/L、(9.42±3.09) U/L비(5.79±2.10)U/L、(7.96±2.53)U/L비(6.50±2.71) U/L],차이유통계학의의(P＜0.05).연구조치료후혈청β-hCG회복정상기1,3개월혈청자이순(E2)화항묘륵관격소(AMH)수평저우대조조[E2:(111.44±22.24)pmol/L비(128.22±24.01) pmol/L,(108.74±21.67) pmol/L비(126.30±23.78) pmol/L;AMH:(3.22±0.85)μg/L비(3.64±0.87) μg/L,(3.67±0.94) μ g/L비(3.83±1.12) μg/L],차이유통계학의의(P＜ 0.05);6개월시량조혈청E2화AMH수평비교차이무통계학의의[E2:(127.85±24.42) pmol/L비(131.28±25.54) pmol/L;AMH:(4.35±1.34)μg/L비(4.47± 1.76) μg/L](P＞0.05).수란관절제환자술후6개월환측(수란관절제측)란소체적、두란포수현저저우대측[(8.86±2.36) cm3비(9.74±2.31) cm3、(5.10±1.14)개비(7.26±2.52)개],차이유통계학의의(P＜0.05).술후2년대조조이위임신솔고우연구조[12.66％(10/79)비5.10％(8/157)],차이유통계학의의(P＜0.05);우기술중보류적수란관재차이위임신솔경고[8.86％(7/79)비0],차이유통계학의의(P＜0.05).결론 수란관절제술영향환자생식잠능,단가강저재차이위임신적발생솔.수란관임신환자시부행수란관절제술,취결우수란관적병변정황급환자적생육요구.
Objective To analyze the effect on reproductive potential of salpingectomy in child-bearing period women.Methods Two hundred and forty-six tubal pregnancy patients were chosen,among whom 164 patients performed salpingectomy were classified as research group,and 82 patients retained ipsilateral tubal through conservative treatment were classified as control group.The levels of sex hormone,ovarian volume,sinus number of follicle,ovulation rate,reproductive outcome and reproductive status were compared between 2 groups.Seven patients were lost in research group,and 3 patients were lost in control group.Results One,three and six months after β-human chorionic gonadotrophin (β-hCG) put back,the serum levels of follicle stimulating hormone (FSH),luteinizing hormone (LH) in research group were significantly higher than those in control group,FSH:(10.00 ±4.82) U/L vs.(6.69 ± 2.71) U/L,(9.11 ± 3.77)U/L vs.(6.81 ± 2.80) U/L,(8.30 ± 3.49) U/L vs.(6.41 ± 2.41) U/L;LH:(8.74 ± 3.56) U/L vs.(6.10 ± 2.59)U/L,(9.42 ± 3.09) U/L vs.(5.79 ± 2.10) U/L,(7.96 ± 2.53) U/L vs.(6.50 ± 2.71) U/L,and there were statistical differences (P ＜ 0.05).One and three months after β-hCG put back,the serum levels of estradiol (E2) and anti-Mullerian hormone (AMH) in research group were significantly lower than those in control group,E2:(111.44 ± 22.24) pmol/L vs.(128.22 ± 24.01) pmol/L,(108.74 ± 21.67) pmol/L vs.(126.30 ± 23.78) pmol/L;AMH:(3.22 ± 0.85) μ g/L vs.(3.64 ± 0.87) μ g/L,(3.67 ± 0.94) μ g/L vs.(3.83 ± 1.12) μ g/L,and there were statistical differences (P ＜ 0.05).Six months after β-hCG put back,there was no statistical difference in the serum levels of E2 and AMH:(127.85 ± 24.42) pmol/L vs.(131.28 ± 25.54) pmol/L and (4.35 ± 1.34) μ g/L vs.(4.47 ± 1.76) μ g/L,P ＞ 0.05.In salpingectomy patients,the ovarian volume and the sinus number of follicle at lesion side (salpingectomy side) after treatment of 6 months were significantly lower than those in no lesion side:(8.86 ± 2.36) cm3 vs.(9.74 ± 2.31) cm3 and (5.10 ± 1.14) pieces vs.(7.26 ± 2.52) pieces,and there were statistical differences (P ＜ 0.05).After treatment of 2 years,the rate of ectopic pregnancy in control group was significantly higher than that in research group:12.66％ (10/79) vs.5.10％(8/157),and there was statistical difference (P ＜ 0.05).Especially,the patients who retained ipsilateral tubal conservative treatment had higher ectopic pregnancy rate:8.86％ (7/79) vs.0,and there was statistical difference (P ＜ 0.05).Conclusions Salpingectomy can affect the reproductive potential,but it can decrease the probability of ectopic pregnancy.Whether patients with tubal pregnancy need to be treated by salpingectomy,depends on the extent of tubal lesions and fertility desire of the patients.
