Department of Obstetrics & Gynecology, Magna Graecia University-Gynecologic Oncology Unit, Tommaso Campanella Cancer Center of Germaneto, Catanzaro, Italy.
Gynecol Oncol. 2013 Jun;129(3):448-51. doi: 10.1016/j.ygyno.2013.03.023. Epub 2013 Apr 2.
The objective of this study is to compare ovarian function and surgical outcomes between patients affected by benign uterine pathologies submitted to total laparoscopic hysterectomy (TLH) plus salpingectomy and women in which standard TLH with adnexal preservation was performed.
We retrospectively compared data of 79 patients who underwent TLH plus bilateral salpingectomy (group A), with those of 79 women treated by standard TLH without adnexectomy (sTLH) (group B). Ovarian reserve modification, expressed as the difference between 3 months post-operative and pre-operative values of Anti-Müllerian Hormone (AMH), Follicle Stimulating Hormone (FSH), Antral Follicle Count (AFC), mean ovarian diameters and Peak Systolic Velocity (PSV), was recorded for each patient. For each surgical procedure, operative time, variation of hemoglobin level (ΔHb), postoperative hospital stay, postoperative return to normal activity, and complication rate were recorded as secondary outcomes.
According to our post-hoc analysis, this equivalence study resulted to have a statistical power of 96.8%. Significant difference was not observed between groups with respect to ΔAMH (p=0.35), ΔFSH (p=0.15), ΔAFC (p=0.09), Δ mean ovarian diameters (p=0.57) and ΔPSV (p=0.61). In addition, secondary outcomes such as operative time (p=0.79), ΔHb (p=0.41), postoperative hospital stay (p=0.16), postoperative return to normal activity (p=0.11) and complication rate also did not show any significant difference.
The addition of bilateral salpingectomy to TLH for prevention of ovarian cancer in women who do not carry a BRCA1/2 mutations do not show negative effects on the ovarian function. In addition, no perioperative complications are related to the salpingectomy step in TLH.
本研究旨在比较行完全腹腔镜子宫切除术（TLH）加输卵管切除术的良性子宫病变患者与行标准 TLH 加附件保留术的患者之间的卵巢功能和手术结果。
我们回顾性比较了 79 例行 TLH 加双侧输卵管切除术（A 组）和 79 例行标准 TLH 无附件切除术（sTLH）（B 组）的患者数据。记录每位患者术后 3 个月与术前的抗苗勒管激素（AMH）、卵泡刺激素（FSH）、窦卵泡计数（AFC）、平均卵巢直径和峰值收缩速度（PSV）差值，以评估卵巢储备功能的改变。对于每种手术，记录手术时间、血红蛋白水平变化（ΔHb）、术后住院时间、术后恢复正常活动时间和并发症发生率作为次要结局。
根据我们的事后分析，本等效性研究具有 96.8%的统计效力。两组间 ΔAMH（p=0.35）、ΔFSH（p=0.15）、ΔAFC（p=0.09）、Δ平均卵巢直径（p=0.57）和 ΔPSV（p=0.61）差异无统计学意义。此外，手术时间（p=0.79）、ΔHb（p=0.41）、术后住院时间（p=0.16）、术后恢复正常活动时间（p=0.11）和并发症发生率等次要结局也无显著差异。
对于不携带 BRCA1/2 突变的妇女，TLH 加双侧输卵管切除术预防卵巢癌不会对卵巢功能产生负面影响。此外，TLH 中的输卵管切除术步骤与围手术期并发症无关。
