Clinical Application of Single-port Laparoscopic Salpingectomy with Preserved Salpingum Mesothelium and its Influence on Ovarian Reserve Function and Assisted Pregnancy Outcome
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摘要:
目的 探讨单孔腹腔镜下保留输卵管系膜的输卵管切除术的临床应用及对卵巢储备功能、助孕结局的影响。 方法 选取2019年1月至2022年1月在双鸭山双矿医院接受保留输卵管系膜的输卵管切除术80例，采用随机数字表法分为对照组（n = 40）和观察组（n = 40）。对照组行多孔腹腔镜下保留输卵管系膜输卵管切除术，观察组行单孔腹腔镜下保留输卵管系膜输卵管切除术。分析2组手术情况（手术时间、术中出血量、排气时间等）、术前及术后1个月抗苗勒管激素（anti-Müllerianhormon，AMH）、卵巢功能（基础窦卵泡计数）、术后并发症、助孕结局及美容效果。 结果 观察组排气时间、术后住院时间短于对照组，手术时间长于对照组（P < 0.05）；术后1个月，2组AMH均下降，观察组A低于对照组，窦卵泡数多于对照组；并发症概率低于对照组（P < 0.05）；随访1 a，2组排卵率及妊娠率比较无统计学意义（P > 0.05）；随访3个月，观察组美容效果优于对照组（95.00% VS 72.50%）（P < 0.05）。 结论 单孔腹腔镜下保留输卵管系膜的输卵管切除术具有安全性、美容性、微创性，对卵巢储备功能的不良影响较小，有助于成功助孕，值得在临床应用推广。 -
关键词:
- 单孔腹腔镜 /
- 保留输卵管系膜的输卵管切除术 /
- 卵巢储备功能 /
- 助孕结局
Abstract:Objective To explore the clinical application of salpingectomy with preserving salpingum mesothelium under single-port laparoscopy and its influence on ovarian reserve function and assisted pregnancy outcome. Methods From January 2019 to January 2022, 80 cases of salpingectomy in Shuangyashan Double Mine Hospital were selected and randomly divided into control group （n = 40） and observation group （n = 40） . The control group was treated with multi-hole laparoscopic salpingectomy with salpingum mesothelium preserved, while the observation group was treated with single-hole laparoscopic salpingectomy with salpingum mesothelium preserved. The operation conditions （operation time, intraoperative blood loss, exhaust time, etc.）, anti-Mullerian hormone （AMH） before and one month after operation, ovarian function （basal sinus follicle count）, postoperative complications, assisted pregnancy outcome and cosmetic effect were analyzed. Results The exhaust time and postoperative hospitalization time in the observation group were shorter than those in the control group, and the operation time was longer than that in the control group （P < 0.05）. One month after operation, AMH in both groups decreased, and the number of sinus follicles in observation group A was lower than that in control group. The complication rate was lower than that of the control group （P < 0.05）. After a one-year follow-up, there was no significant difference in ovulation rate and pregnancy rate between the two groups （P > 0.05）. Follow-up for 3 months showed that the cosmetic effect of the observation group was better than that of the control group（95.00% vs 72.50%） （P < 0.05）. Conclusion Single-port laparoscopic salpingectomy with salpingum mesothelium preservation is safe, cosmetic and minimally invasive, and has little adverse effect on ovarian reserve function, which is helpful for successful pregnancy assistance and worthy of clinical application and promotion. -
表 1 基线资料对比[$ \bar x \pm s $，n（%）]
Table 1. Comparison of baseline data [$ \bar x \pm s $，n（%）]
项目 组别 t/χ2 P 观察组（n=40） 对照组（n=40） 年龄（岁） 26.82±6.90 27.92±7.61 0.678 0.500 BMI（kg/m2） 22.76±4.87 23.94±5.20 1.048 0.298 停经时间（d） 52.77±18.55 48.57±19.23 0.994 0.323 包块最大径线（mm） 27.57±18.29 25.78±15.68 0.470 0.640 后陷凹积液深度（mm） 30.64±12.93 31.89±14.65 0.405 0.687 术前血β-hCG（mIU/mL） 3120.65±2763.01 2665.7±1934.41 0.853 0.396 输卵管妊娠部位 峡部 11（27.50） 14（35.00） 0.524 0.469 壶腹部 29（72.50） 26（65.00） 顺产史 有 19（47.50） 18（45.00） 0.050 0.823 无 21（52.50） 22（55.00） 剖宫产史 有 8（20.00） 9（22.50） 0.075 0.785 无 32（80.00） 31（77.50） 其他腹部手术史 有 7（17.50） 11（27.50） 1.147 0.284 无 33（82.50） 29（72.50） 人流术史 有 30（75.00） 28（70.00） 0.251 0.617 无 10（25.00） 12（30.00） 
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表 2 2组手术相关指标比较（$ \bar x \pm s $，n = 40）
Table 2. Comparison of surgical related indexes between the two groups（$ \bar x \pm s $，n = 40）
项目 组别 t P 观察组（n=40） 对照组（n=40） 手术时间（min） 52.21±10.62** 37.75±8.95 6.585 <0.001** 术中出血量（mL） 33.28±9.34 34.57±9.62 3.436 0.545 排气时间（h） 30.74±5.94** 36.85±6.73 4.305 <0.001** 术后住院时间（h） 45.52±7.32** 65.42±6.21 13.111 <0.001** 与对照组比较，**P < 0.01。
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表 3 AMH及卵巢功能（$ \bar x \pm s $，n = 40）
Table 3. AMH and ovarian function（$ \bar x \pm s $，n = 40）
组别 AMH（ng/mL） 卵巢功能 术前 术后1个月 术后1个月窦卵泡数 观察组（n=40） 2.13±0.40 0.81±0.28** 8.11±3.32* 对照组（n=40） 2.16±0.43 2.00±0.33 5.98±2.50 t 0.323 17.390 3.241 P 0.747 <0.001** 0.002* 与对照组比较，*P < 0.05，**P < 0.01。
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表 4 并发症[n（%）]
Table 4. Complications[n（%）]
组别 感染 渗液 腹腔脏器损伤 切口疝 总发生率 观察组（n=40） 0 0 0 0 0 对照组（n=40） 1（2.5） 2（5.00） 1（2.5） 2（5.00） 6（15.00） χ2 − − − − 4.504 P − − − − 0.034* 与对照组比较，*P < 0.05。
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表 5 排卵率及妊娠率比较[n（%）]
Table 5. Comparison of ovulation rate and pregnancy rate[n（%）]
组别 排卵率 妊娠率 观察组（n=40） 23（57.50） 21（52.50） 对照组（n=40） 20（50.00） 19（47.50） χ2 0.453 0.200 P 0.501 0.655
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表 6 美容效果比较[n（%）]
Table 6. Comparison of beauty effects[n（%）]
组别 美容效果良好 美容效果欠佳 观察组（n=40） 38（95.00）* 2（5.00） 对照组（n=40） 29（72.50） 11（27.50） χ2 7.439 P 0.006* 与对照组比较，*P < 0.05。
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