Kotlyar Alexander, Gingold Julian, Shue Shirley, Falcone Tommaso
Department of Obstetrics and Gynecology and Women's Health Institute, The Cleveland Clinic, Cleveland, Ohio.
Department of Obstetrics and Gynecology and Women's Health Institute, The Cleveland Clinic, Cleveland, Ohio.
J Minim Invasive Gynecol. 2017 May-Jun;24(4):563-578. doi: 10.1016/j.jmig.2017.02.014. Epub 2017 Feb 20.
Tubal surgery is performed for a variety of indications in gynecology. Salpingectomy is the most aggressive form of tubal surgery and may be performed for potential risk reduction for epithelial ovarian cancer, sterilization, and ectopic pregnancy and as a method to enhance fertility in the setting of hydrosalpinx. Depending on the indication, alternatives include conservative therapy alone, tubal occlusion, and salpingostomy. However, aggressive tubal surgery may impact fertility and ovarian reserve because of its effects on adjacent ovarian tissue. Ovarian damage may manifest as alterations in serum and sonographic markers of ovarian function as well as in vitro fertilization (IVF) response and, ultimately, impair outcomes in assisted reproductive and spontaneous conception cycles. We performed a review of articles from PubMed, Cochrane, and MEDLINE from 1946 to 2016 and included 48 relevant publications. For most indications for salpingectomy, ovarian reserve is not impacted. Although there are several conflicting studies suggesting a slight impairment of the parameters of ovarian reserve, these studies were mostly in patients who underwent salpingectomy for an ectopic pregnancy. For patients attempting to conceive naturally, salpingectomy overall does not confer a substantial decrease in conception. Conservative options may increase their risk for persistent trophoblastic disease. In patients planning on IVF, salpingectomy does not appear to significantly affect ovarian stimulation parameters or clinical pregnancy rates. Furthermore, salpingectomy is recommended in cases of hydrosalpinx. Overall, salpingectomy has no significant effects on ovarian reserve. However, the impact on IVF success and spontaneous pregnancy rates must be weighed by the indication for possible salpingectomy. A review of these risks and benefits should aid in choosing between salpingectomy and less aggressive alternatives.
输卵管手术在妇科中有多种适应证。输卵管切除术是输卵管手术中最激进的形式，可用于降低上皮性卵巢癌的潜在风险、绝育、治疗异位妊娠，以及作为改善输卵管积水情况下生育能力的一种方法。根据适应证的不同，替代方案包括单纯保守治疗、输卵管阻塞和输卵管造口术。然而，激进的输卵管手术可能会因其对邻近卵巢组织的影响而影响生育能力和卵巢储备。卵巢损伤可能表现为卵巢功能的血清学和超声标志物改变，以及体外受精（IVF）反应，最终损害辅助生殖和自然受孕周期的结局。我们对1946年至2016年来自PubMed、Cochrane和MEDLINE的文章进行了综述，纳入了48篇相关出版物。对于大多数输卵管切除术的适应证，卵巢储备不受影响。尽管有几项相互矛盾的研究表明卵巢储备参数略有受损，但这些研究大多针对因异位妊娠接受输卵管切除术的患者。对于试图自然受孕的患者，总体而言，输卵管切除术不会使受孕率大幅下降。保守选择可能会增加持续性滋养细胞疾病的风险。对于计划进行IVF的患者，输卵管切除术似乎不会显著影响卵巢刺激参数或临床妊娠率。此外，输卵管积水的情况下建议进行输卵管切除术。总体而言，输卵管切除术对卵巢储备没有显著影响。然而，对IVF成功率和自然妊娠率的影响必须根据可能进行输卵管切除术的适应证来权衡。对这些风险和益处的综述应有助于在输卵管切除术和较不激进的替代方案之间做出选择。
