探讨输卵管积水腹腔镜下不同手术方式对卵巢储备功能的影响。

将2008年1月至2009年1月接受体外受精胚胎移植(in vitro fertilization–embryo transfer, IVF–ET)前，因输卵管积水在本院行腹腔镜手术预处理的58例不孕患者，按手术方式分为两组。A组(n＝28)行双侧输卵管近端结扎远端造口术，B组(n＝30)行双侧输卵管切除术(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准，得到该委员会批准，分组征得受试对象的知情同意，并与之签署临床研究知情同意书)。观察两组术前及术后第1、第3个月经周期第3天的血清雌二醇(estradiol, E₂)，卵泡刺激素(follicle stimulating hormone，FSH)水平，以及术后月经恢复情况。

A组患者手术前、后卵泡刺激素水平比较，差异无显著意义(P>0.05)。B组患者术后第1个月经周期卵泡刺激素水平与术前相比，差异有显著意义(P<0.05)，术后第1个月经周期卵泡刺激素水平与术后第3个月经周期比较，差异无显著意义(P>0.05)。A组和B组卵泡刺激素水平在术后第1个月经周期比较，差异有显著意义(P<0.05)，在术后第3个月经周期比较，差异无显著意义(P>0.05)。A，B组手术前、后血清雌二醇水平比较，差异均无显著意义(P>0.05)。A，B组术后第1个月经周期恢复情况比较，差异有显著意义(χ²＝2.678，P<0.05)，术后第3个月经周期时，两组均恢复正常。

腹腔镜下输卵管积水采取输卵管切除术对卵巢储备功能及月经恢复在近期有一定影响，输卵管近端结扎远端造口术对其无明显影响。

To evaluate effects of different laparoscopic procedures for hydrosalpinx on ovarian reserve.

A total of 58 infertile women who had laparoscopic operation because of hydrosalpinx before in vitro fertilization-embryo transfer(IVF-ET) from January 2008 to January 2009. All the patients were divided into two groups according to the different laparoscopic managements. Group A(n=28) were treated with laparoscopic proximal tubal ligament and distal tubal salpingostomy, and group B(n=30) were treated with salpingostomy. Informed consent was obtained from all participants. The level of estradiol(E₂) and follicle stimulating hormone(FSH) before the operation and at the third day of the first and third menstrual cycle after the operation were observed, and the menstruation recovery was evaluated.

The level of estradiol and follicle stimulating hormone of group A had no statistical difference before and after the operation(P>0.05). In group B, the level of follicle stimulating hormone at the third day of first menstrual cycle after the operation had significant different compared with pre-operation (P<0.05). There had no significant difference between the level of follicle stimulating hormone at the third day of the first and third menstrual cycle (P>0.05). There had significant difference of follicle stimulating hormone level of the first menstrual cycle between two groups (P<0.05), but had no significant difference of the third menstrual cycle(P>0.05). There had statistical difference of menstrual recovery of the first menstrual cycle after operation between group A and B(χ²=2.678, P<0.05). Both two groups were recovered to normal in the third menstrual cycle after the operation.

Laparosopic salpingectomy had statistical significant effects on ovarian reserve and the recovery of the menstruation in the near future. Laparoscopic proximal tubal ligament and distal tubal salpingostomy may be considered for a better treatment of hydrosalpinx prior to in vitro fertilization-embryo transfer.