Asgari Zahra, Tehranian Afsaneh, Rouholamin Safoura, Hosseini Reihaneh, Sepidarkish Mahdi, Rezainejad Mahroo
Department of Obstetrics and Gynecology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
J Cancer Res Ther. 2018 Apr-Jun;14(3):543-548. doi: 10.4103/0973-1482.193114.
This study aimed to compare the surgical outcome and ovarian reserve in premenopausal women undergoing laparoscopic hysterectomy (without oophorectomy) for benign cause between two methods of with and without prophylactic bilateral salpingectomy.
In a prospective randomized clinical trial, 62 premenopausal women with benign indication underwent a laparoscopic hysterectomy. Patients were then randomized to undergo hysterectomy with bilateral salpingectomy (Group 1; n = 15) or without bilateral salpingectomy (Group 2; n = 15). We evaluated the impact of bilateral salpingectomy on surgical outcome and ovarian reserve using serum levels of anti-Mullerian hormone (AMH) and follicle stimulating hormone (FSH) that were measured preoperatively and at 3 months postoperatively (P < 0.001).
Baseline characteristics such as age, uterine size, body mass index, and preoperative AMH and FSH levels were similar between the two study groups. The average operative time, estimated blood loss, uterine size, uterine weight, and intraoperative complication were similar between two groups. The mean AMH levels were not significantly different at baseline (1.44 ng/mL vs. 1.2 ng/mL) and at 3-month postoperatively (1.13 ng/mL vs. 0.97 ng/mL) among women with salpingectomy versus no salpingectomy. At 3-month follow-up, in both groups, postoperative AMH levels were significantly lower and FSH levels were significantly higher than before surgery.
Prophylactic bilateral salpingectomy at the time of laparoscopic hysterectomy neither has a negative effect on ovarian reserve nor increases the surgical risk. Therefore, we may recommend gynecologic surgeons to perform prophylactic bilateral salpingectomy during laparoscopic hysterectomy to conserve both ovaries.
本研究旨在比较因良性病因接受腹腔镜子宫切除术（不切除卵巢）的绝经前女性，在进行预防性双侧输卵管切除术和不进行预防性双侧输卵管切除术这两种方法下的手术结果及卵巢储备情况。
在一项前瞻性随机临床试验中，62名有良性指征的绝经前女性接受了腹腔镜子宫切除术。然后将患者随机分为接受双侧输卵管切除术的子宫切除术组（第1组；n = 15）和不接受双侧输卵管切除术的子宫切除术组（第2组；n = 15）。我们通过术前及术后3个月测量的抗苗勒管激素（AMH）和促卵泡生成素（FSH）血清水平，评估双侧输卵管切除术对手术结果和卵巢储备的影响（P < 0.001）。
两个研究组之间的基线特征，如年龄、子宫大小、体重指数以及术前AMH和FSH水平相似。两组之间的平均手术时间、估计失血量、子宫大小、子宫重量和术中并发症相似。输卵管切除术组与未进行输卵管切除术组的女性在基线时（1.44 ng/mL对1.2 ng/mL）和术后3个月时（1.13 ng/mL对0.97 ng/mL）的平均AMH水平无显著差异。在3个月的随访中，两组术后AMH水平均显著低于术前，FSH水平均显著高于术前。
腹腔镜子宫切除术时进行预防性双侧输卵管切除术，既不会对卵巢储备产生负面影响，也不会增加手术风险。因此，我们建议妇科外科医生在腹腔镜子宫切除术期间进行预防性双侧输卵管切除术，以保留双侧卵巢。
